bluuebunny/crossref_metadata_2025 huggingface dataset:
Patterns of Prescription of Psychotropic Medications and Their Adherence among Patients with Schizophrenia in Two Psychiatric Hospitals in Accra, Ghana: A Cross-Sectional Survey
Authors: Ashong Sharon , Kretchy Irene A. , Afrane Barima , de-Graft Aikins Ama
Published: January 2018

Background. Patients with schizophrenia are managed with antipsychotics and other psychotropic medications. Objectives. This study aimed to assess the commonly prescribed psychotropic medications for patients with schizophrenia, explore the types of therapeutic monitoring that were performed, and find out whether the side effects experienced by the patients played any role in their adherence behaviour. Methods. This hospital-based cross-sectional study enrolled 259 patients with schizophrenia from Accra Psychiatric Hospital and Pantang Psychiatric Hospital. Data were collected on mental status, side effects, types of therapeutic monitoring performed, and adherence behaviour. Results. Olanzapine was the commonly prescribed psychotropic medication. Most of respondents (73.4%) experienced mild levels of side effects. The negative effects were predominantly genitourinary (26%) and gastrointestinal (17.2%). Blood pressure and heart rate measures were the main types of monitoring performed but no measurement of drug levels was reported. About 98.1% of the participants poorly adhered to their medications and the major reasons for poor adherence were economic challenges, forgetfulness, and the feeling of wellness. Conclusion. Adherence to medication is a major health problem among patients with schizophrenia and there is a need to improve adherence and treatment outcomes.
CCR5+ Myeloid-Derived Suppressor Cells Are Enriched and Activated in Melanoma Lesions
Authors: Blattner Carolin , Fleming Viktor , Weber Rebekka , Himmelhan Bianca , Altevogt Peter , Gebhardt Christoffer , Schulze Torsten J. , Razon Hila , Hawila Elias , Wildbaum Gizi , Utikal Jochen , Karin Nathan , Umansky Viktor
Published: January 2018

Accumulation of myeloid-derived suppressor cells (MDSC) in melanoma microenvironment is supported by chemokine receptor/chemokine signaling. Although different chemokines were suggested to be involved in this process, the role of CCR5 and its ligands is not established. Using a Ret transgenic mouse melanoma model, we found an accumulation of CCR5+ MDSCs in melanoma lesions associated with both increased concentrations of CCR5 ligands and tumor progression. Tumor-infiltrating CCR5+ MDSCs displayed higher immunosuppressive activity than their CCR5− counterparts. Upregulation of CCR5 expression on CD11b+Gr1+ myeloid cells was induced in vitro by CCR5 ligands and other inflammatory factors. In melanoma patients, CCR5+ MDSCs were enriched at the tumor site and correlated with enhanced production of CCR5 ligands. Moreover, they exhibited a stronger immunosuppressive pattern compared with CCR5− MDSCs. Blocking CCR5/CCR5 ligand interactions increased survival of tumor-bearing mice and was associated with reduced migration and immunosuppressive potential of MDSCs in tumor lesions. Our findings define a critical role for CCR5 in recruitment and activation of MDSCs, suggesting a novel strategy for melanoma treatment.

Significance: These findings validate the importance of the CCR5/CCR5 ligand axis not only for MDSC recruitment but also for further activation of their immunosuppressive functions in the tumor microenvironment, with potentially broad therapeutic implications, given existing clinically available inhibitors of this axis. Cancer Res; 78(1); 157–67. ©2017 AACR.
Translating Science into Survival: Report on the Third International Cancer Immunotherapy Conference
Authors: Diken Mustafa , Chu Karen K. , Brodsky Arthur N.
Published: January 2018

On September 6 to 9, 2017, in Mainz, Germany, the Third International Cancer Immunotherapy Conference was hosted jointly by the Cancer Research Institute, the Association for Cancer Immunotherapy, the European Academy of Tumor Immunology, and the American Association for Cancer Research. For the third straight year, more than 1,400 people attended the four-day event, which covered the latest advances in cancer immunology and immunotherapy. This report provides an overview of the main topics discussed. Cancer Immunol Res; 6(1); 10–13. ©2017 AACR.
Dynamic Influence of pH on Metalloproteinase Activity in Human Coronal and Radicular Dentin
Authors: Amaral Stella F. do , Scaffa Polliana M.C. , Rodrigues Renata D.S. , Nesadal Douglas , Marques Marcia M. , Nogueira Fernando N. , Sobral Maria Angela Pita
Published: January 2018

The aim of this study was to evaluate the effect of pH on the activation of matrix metalloproteinases (MMPs) of human coronal (CD) and radicular dentin (RD). CD and RD were pulverized to powder, and proteins were extracted with 1% phosphoric acid. The extracted proteins and the demineralized powder were separately incubated in the following solutions: 4-aminophenylmercuric acetate (control) or a buffer solution at different pHs (2.5, 4.5, 5.0, 6.0, and 7.0). After incubation, proteins were separated by electrophoresis to measure MMP activities by zymography. To assess the solubilized dentin collagen, the demineralized dentin powder was sustained in incubation buffer, and the amount of hydroxyproline (HYP) released was measured. Zymography revealed MMP-2 gelatinolytic activities for CD and RD in all experimental groups. For both substrates, the lowest pH solutions (2.5, 4.5, and 5.0) yielded higher gelatinolytic activity than those obtained by the highest pH solutions (6.0 and 7.0). For HYP analysis, no detectable absorbance values were observed for pHs of 2.5 and 4.5. The amount of HYP was higher for pH 7.0 than those of all other groups (p < 0.05), except for pH 6.0. No statistical differences were found between pHs 6.0 and 5.0 and control (p > 0.05). The MMP-2 enzyme from human CD and RD is dynamically influenced by pH: at low pH, the extracted enzyme activates this latent form, whereas collagen degradation by the matrix-bound enzyme is only observed when pHs are close to neutral.
Hepatic Pseudolymphoma with Fluorodeoxyglucose Uptake on Positron Emission Tomography
Authors: Suzumura Kazuhiro , Hatano Etsuro , Okada Toshihiro , Asano Yasukane , Uyama Naoki , Hai Seikan , Kurimoto Ami , Nonaka Kentaro , Tsujimura Tohru , Fujimoto Jiro
Published: January 2018

A 69-year-old woman with chronic hepatitis B was admitted to our hospital with a hepatic tumor. The levels of 2 tumor markers, carcinoembryonic antigen and carbohydrate antigen 19-9, were slightly elevated; however, the α-fetoprotein and protein levels induced by vitamin K antagonist II were within the normal limits. Abdominal ultrasonography showed a well-defined peripheral hypoechoic mass that was isoechoic and homogeneous on the inside. Computed tomography showed a poorly enhanced tumor of 13 mm in diameter in the 5th segment of the liver. Fluorodeoxyglucose positron emission tomography showed a slight uptake (maximum standard uptake value 3.4) by the hepatic tumor. These findings suggested cholangiocellular carcinoma, and we performed anterior segmentectomy of the liver. A histopathological examination showed a hepatic pseudolymphoma. The patient’s postoperative course was uneventful, and she remains alive without recurrence 5 months after undergoing surgery. In most cases, hepatic pseudolymphoma is preoperatively diagnosed as a malignant tumor and a definite diagnosis is made after resection. It is therefore necessary to consider hepatic pseudolymphoma as a differential diagnosis in patients with hepatic tumors.
Effect of Cochlear Implantation on Quality of Life in Adults with Unilateral Hearing Loss
Authors: Dillon Margaret T. , Buss Emily , Rooth Meredith A. , King English R. , Deres Ellen J. , Buchman Craig A. , Pillsbury Harold C. , Brown Kevin D.
Published: January 2018

Objective: Patients with moderate-to-profound sensorineural hearing loss in 1 ear and normal hearing in the contralateral ear, known as unilateral hearing loss (UHL) or single-sided deafness (SSD), may experience improved quality of life with the use of a cochlear implant (CI) in the affected ear. Quality of life assessment before and after implantation may reveal changes to aspects of hearing beyond those explicitly evaluated with behavioral measures. Methods: The present report completed 2 experiments investigating quality of life outcomes in CI recipients with UHL. The first experiment assessed quality of life during the 1st year of device use with 3 questionnaires: the Speech, Spatial, and Qualities of Hearing Scale (SSQ), the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the Tinnitus Handicap Inventory. Twenty subjects were evaluated preoperatively and 1, 3, 6, 9, and 12 months post-activation. Quality of life results were compared over the study period using traditional scoring methods and the SSQ pragmatic subscales. Subscales specific to localization and speech perception in noise were compared to behavioral measures at the preoperative and 12-month intervals. The 2nd experiment evaluated quality of life preoperatively and at the 12-month interval for CI recipients with UHL and CI recipients with bilateral hearing loss, including conventional CI users and those listening with electric-acoustic stimulation (EAS). The 3 cohorts differed in CI candidacy criteria, including the amount of residual hearing in the contralateral ear. Results: For subjects with moderate-to-profound UHL, receipt of a CI significantly improved quality of life, with benefits noted as early as 1 month after initial activation. The UHL cohort reported less perceived difficulty at the pre- and postoperative intervals than the conventional CI and EAS cohorts, which may be due to the presence of the normal-hearing ear. Each group experienced a significant benefit in quality of life on the APHAB with CI use. Conclusions: Cochlear implantation in cases of substantial UHL may offer significant improvements in quality of life. Quality of life measures revealed a reduction in perceived tinnitus severity and subjective improvements in speech perception in noise, spatial hearing, and listening effort. While self-report of difficulties were lower for the UHL cohort than the conventional CI and EAS cohorts, subjects in all 3 groups reported an improvement in quality of life with CI use.
Effect of Posterior Fossa Decompression for Chiari Malformation-I on Scoliosis
Authors: Chotai Silky , Basem Jade , Gannon Stephen , Dewan Michael , Shannon Chevis N. , Wellons John C. , Bonfield Christopher M.
Published: January 2018

Background/Aims: Scoliosis is common in patients with Chiari malformation-I (CM-I). This study examined the change in scoliosis severity after posterior fossa decompression (PFD) for CM-I. Methods: We conducted a retrospective review at a single tertiary center for children undergoing PFD with untreated scoliosis, and identified 17 patients with complete follow-up data and imaging. Results: Overall, scoliosis improved in 7 (41.2%) patients, worsened in 9 (52.9%), and remained unchanged in 1 (5.9%) after PFD (mean follow-up of 7.8 ± 4.1 months). We found that 3 of the 8 (38%) children with early-onset scoliosis eventually needed scoliosis corrective surgery, which was needed in 7 of the 9 (78%) patients with adolescent-onset scoliosis. In addition, only 1 patient (17%) with a preoperative scoliosis curve <35 degrees and 9 patients (82%) with a curve ≥35 degrees required surgery for scoliosis correction despite PFD (p = 0.018). Conclusion: In certain patients, PFD for CM-I may lead to improvement or stabilization of scoliosis.
LPS Promotes Vascular Smooth Muscle Cells Proliferation Through the TLR4/Rac1/Akt Signalling Pathway
Authors: Yin Qianran , Jiang Dehua , Li Lei , Yang Yu , wu Pei , Luo Yuanyuan , Yang Rongli , Li Dongye
Published: January 2018

Background/Aims: Lipopolysaccharide (LPS) is a potent activator of vascular smooth muscle cells (VSMCs) proliferation, but the underlying mechanism remains unknown. In this study, we knocked down Toll-like receptor 4 (TLR4) and Ras-related C3 botulinum toxin substrate 1 (Rac1) expression using small interfering RNA (siRNA) in order to investigate the effects and possible mechanisms of LPS-induced VSMCs proliferation. Methods: VSMCs proliferation was monitored by 5-ethynyl-2’-deoxyuridine staining, and Rac1 activity was measured via Glutathione S-transferase pull-down assay. mRNAs encoding proliferating cell nuclear antigen (PCNA), smooth muscle 22α (SM22α), myosin heavy chain (MYH) and transient receptor potential channel 1 (TRPC1) were detected by qRT-PCR. The expression of total Akt, p-Akt (308), p-Akt (473), SM22α, MYH and TRPC1 protein was analysed by Western blot. Results: Treatment with TLR4 siRNA (siTLR4) or Rac1 siRNA (siRac1) significantly decreased LPS-induced VSMCs proliferation. Moreover, LPS-induced activation of Rac1 through TLR4 was observed. Western blot analysis revealed that transfection with siTLR4 or siRac1 inhibited LPS-induced Akt phosphorylation. We discovered that LPS stimulated VSMCs proliferation via phenotypic modulation and that this effect was partially inhibited by pre-treatment with siTLR4 or siRac1. Further, TLR4 and Rac1 are involved in LPS-induced activation of TRPC1. Conclusion: This study suggests that LPS exerts an effect on VSMCs proliferation and that the TLR4/Rac1/Akt signalling pathway mediates this effect.
Yes-Associated Protein Promotes Angiogenesis via Signal Transducer and Activator of Transcription 3 in Endothelial Cells
Authors: He Jinlong , Bao Qiankun , Zhang Yan , Liu Mingming , Lv Huizhen , Liu Yajin , Yao Liu , Li Bochuan , Zhang Chenghu , He Shuang , Zhai Guijin , Zhu Yan , Liu Xin , Zhang Kai , Wang Xiu-Jie , Zou Ming-Hui , Zhu Yi , Ai Ding
Published: January 2018

Rationale:

Angiogenesis is a complex process regulating endothelial cell (EC) functions. Emerging lines of evidence support that YAP (Yes-associated protein) plays an important role in regulating the angiogenic activity of ECs.

Objective:

The objective of this study was to specify the effect of EC YAP on angiogenesis and its underlying mechanisms.

Method and Results:

In ECs, vascular endothelial growth factor reduced YAP phosphorylation time and dose dependently and increased its nuclear accumulation. Using Tie2Cre-mediated YAP transgenic mice, we found that YAP promoted angiogenesis in the postnatal retina and tumor tissues. Mass spectrometry revealed signal transducer and activator of transcription 3 (STAT3) as a potential binding partner of YAP in ECs. Western blot and immunoprecipitation assays indicated that binding with YAP prolonged interleukin 6–induced STAT3 nuclear accumulation by blocking chromosomal maintenance 1–mediated STAT3 nuclear export without affecting its phosphorylation. Moreover, angiopoietin-2 expression induced by STAT3 was enhanced by YAP overexpression in ECs. Finally, a selective STAT3 inhibitor or angiopoietin-2 blockage partly attenuated retinal angiogenesis in Tie2Cre-mediated YAP transgenic mice.

Conclusions:

YAP binding sustained STAT3 in the nucleus to enhance the latter’s transcriptional activity and promote angiogenesis via regulation of angiopoietin-2.
Jihadi Rebels in Civil War
Authors: Kalyvas Stathis N.
Published: January 2018

In this essay, I decouple violent jihadism from both religion and terrorism and propose an alternative, nonexclusive understanding of jihadi groups as rebel groups engaged in civil wars. Arguing that jihadi groups can be profitably approached as the current species of revolutionary insurgents, I offer a comparison with an older species, the Marxist rebels of the Cold War. I point to a few significant similarities and differences between these two types of revolutionary rebels and draw some key implications, stressing the great challenges facing jihadi rebels in civil wars.
The Practicalities of Living with Failed States
Authors: Mesfin Seyoum , Beyene Abdeta Dribssa
Published: January 2018

State security and survival are critical issues in the rough regional environment of the Horn of Africa. Ensuring security for a state and its population is a priority and a raison d'ětre for any government. The buffer zone has emerged as a key strategy for nations in the Horn of Africa to manage successfully the security challenges of the several failed states in their neighborhood. Buffer zones are established adjacent to the borders of stronger states that oversee the buffer zones' affairs directly or through proxies. This essay explores the practical aspects of power asymmetries between successful and failed states from the perspectives of two officials in successful states who deal directly with this security challenge within the constraints of current norms and practices of sovereignty. The situation in the Horn of Africa provides insights into the effects of failed states on the security of their neighbors and the challenges that failed states present to the wider international community.
Does John 8:44 Imply That the Devil Has a Father?
Authors: Llewelyn Stephen Robert , Robinson Alexandra , Wassell Blake Edward
Published: January 2018

John 8:44 has been a source of concern because of its ambiguity. Is it to be read “of (your) father, the devil” or “of the father of the devil”? This article contends that the former, traditional reading is not ungrammatical as suggested in the grammars and more recently by DeConick and that accordingly the verse cannot be considered pro-gnostic.
The Lord’s Prayer as Song: Performance, Gesture and Meaning
Authors: Haste Amanda J.
Published: January 2018

The Lord’s Prayer is a central text in Christian liturgy, generally recited rather than sung, often as a communal act of worship. The text has also provided inspiration for many musical settings, a process of ‘musicking’ [musikierung] which takes the text out of its traditional worship environment. The internet – and specifically video-streaming sites such as YouTube – are now providing a medium for the dissemination of stage, screen, studio and audio performances of the Lord’s Prayer as song, and these are now reaching – and speaking to – new audiences up to eighty years after they were made; the fact that individuals continue to post video and audio content of the Lord’s Prayer as song reflects their desire to share something which has moved them, whether musically or spiritually, with a worldwide audience.

In liberating the text from its liturgical context and releasing it as song into classical, jazz, rock, and pop performance arenas, many questions are raised about the transformation of textual meaning and ritual significance. The aim of this study is to examine the meaningfulness of the musico-textual setting for the receiver, firstly through the question of ownership of the text as a communal prayer, and secondly in arguing that perception and reception of the performer are contributory factors in the relative positivity or negativity of the receiver’s response. The research was carried out by examining a selection of the legion twentieth- and twenty-first-century musical settings of the Lord’s Prayer readily accessible through YouTube, using ethnographic data from on-line comments and from the author’s on-line survey of Christian worshippers to explore the issues raised by these musical settings. These include the perceived right of an individual to ‘perform’ a mutually-owned prayer; the loss of ritual functionality engendered by the ‘musicking’ of the text and its release into the popular domain; and the additional layers of meaning afforded to the text by gestures in performance, which can in turn lead to a transformation and renewal of ritual significance for the receiver. The inclusion of hyperlinks to YouTube video content throughout the article encourages the reader to engage with the performances themselves, from which it is hoped that a fruitful discussion of the issues will emerge.
Excess, Artifice, Sentimentality: Almodóvar's Camp Cinema as a Challenge for Theological Aesthetics
Authors: Knauss Stefanie
Published: January 2018

Camp is defined as a style that is characterised by excess, artificiality, theatricality, exaggeration, sentimentality. What could this possibly contribute to Christian theological aesthetics, the study of God and theological issues through the aesthetic, art, beauty? This paper proposes, through a discussion of camp in its “incarnation” in Pedro Almodóvar’s cinema, that it has several aspects to offer. Camp uncovers and challenges the categories of truth and reality in theological aesthetics as well as the artforms in which this truth can be discovered. Its embrace of the superficial and material can be seen, in theological terms, as an incarnational aesthetics that offers redemption through the affirmation of the material, not its disruption or negation. Camp underlines the subversive power of pleasure and laughter against tendencies that dismiss pleasure as escapism, and challenges theological aesthetics to acknowledge the wisdom that lies in emotions and affects. It criticizes by fostering solidarity and empathy, rather than antagonism. Thus camp represents a challenge to self-critically reflect on processes of exclusion on an aesthetic and a social level, and challenges us to imagine a different world, a world of beauty, love and passion.
"You're My True Vessel": Knowledge and Digital Fan Culture Discussed on the Basis of Mediumship and Possession in Supernatural's Narrative and Fandom
Authors: Kienzl Lisa
Published: January 2018

Portrayals of mediumship in modern Western television narratives need to be seen as part of a broader phenomenon of the presence of religious elements in Western media, a phenomenon I argue expresses a longing for grand narratives in contemporary Western society. The portrayal and mediatization of religious elements in television narratives as well as their discussion in digital fan culture are part of what I would call a transformation process of knowledge and in particular knowledge of religious phenomena. More specifically, digital fan culture allows for an engagement with discursive transformation processes of knowledge and thus influences what is perceived as knowledge in society. Therefore, religious studies needs to pay closer attention to television narratives and the way fans interact with these narratives to create knowledge about religious practices. This article focuses on how the elements of “possession” and “mediumship” are being transformed by the US American TV series Supernatural and its fan culture. I argue that we can see at least two transformation processes here: the transformation and transplantation of religious concepts and practices (in the case of this article the idea of the human body as spirit medium) into a television context, and the transformation of these concepts and practices through digital fan culture. In its discussion of fan culture, the article looks at and analyzes fan based websites and how they present, discuss and imagine the body-medium.
The Torah in Transition: Imitative Aspects from Codex to Database
Authors: Stewart Emily R.
Published: January 2018

Because the significance of a sacred text comes not only from its content but also its format and materiality, the rise of digital formats is especially a concern for the Jewish community, the ‘people of the book’ (Am ha-Sefer) whose identity is rooted in the Torah. Drawing together scholarship on the history of the book in its changing formats and an illuminative case study of the Jewish Torah in its digital iterations, the Jewish case presented here is instructive but certainly not unique. Despite dramatic changes in reading technology throughout history, readers have time and again used a new technology to perform the same functions as that of the old, only more quickly, with more efficiency, or in greater quantity. While taking advantage of the innovation and novelty which characterize digital formats, a concerted effort to retain much older operations and appearances continues to be made in this transition as well. The analysis in this article aims to further dispel the misguided notion of technological supersession, the idea that new reading technologies ‘kill’ older formats in a straightforward model of elimination.
A Nonparametric Ensemble Postprocessing Approach for Short-Range Visibility Predictions in Data-Sparse Areas
Authors: Ryerson William R. , Hacker Joshua P.
Published: January 2018

This work develops and tests the viability of obtaining skillful short-range (<20 h) visibility predictions using statistical postprocessing of a 4-km, 10-member Weather Research and Forecasting (WRF) ensemble configured to closely match the U.S. Air Force Mesoscale Ensemble Forecast System. The raw WRF predictions produce excessive forecasts of zero cloud water, which is simultaneously predicted by all ensemble members in 62% of observed fog cases, leading to zero ensemble dispersion and no skill in these cases. Adding dispersion to the clear cases by making upward adjustments to cloud water predictions from individual members not predicting fog on their own provides the best chance to increase the resolution and reliability of the ensemble. The technique leverages traits of a joint parameter space in the predictions and is generally most effective when the space is defined with a moisture parameter and a low-level stability parameter. Cross-validation shows that the method adds significant overnight skill to predictions in valley and coastal regions compared to the raw WRF forecasts, with modest skill increases after sunrise. Postprocessing does not improve the highly skillful raw WRF predictions at the mountain test sites. Since the framework addresses only systematic WRF deficiencies and identifies parameter pairs with a clear, non-site-specific physical mechanism of predictive power, it has geographical transferability with less need for recalibration or observational record compared to other statistical postprocessing approaches.
Treatment Preferences in Patients With Early Glottic Cancer
Authors: van Loon Yda , Hendriksma Martine , Langeveld Ton P.M. , de Jong Martin A. , Baatenburg de Jong Rob J. , Sjögren Elisabeth V.
Published: January 2018

Objective:

For early glottic carcinoma, the 2 main treatment modalities are radiotherapy (RT) and transoral CO2 laser microsurgery (TLM). The aim of this study was to investigate treatment preferences and considerations in patients with early glottic carcinoma (T1-T2) who were given a choice between TLM and RT.

Subjects and Methods:

Patients with early glottic cancer (suspected or confirmed extended T1 or limited T2) were counseled by an ENT-surgeon. A subset of 32 patients was also counseled by a radiotherapist. Treatment choice and considerations were recorded and analyzed.

Results:

Of 175 patients, 168 patients (96%) chose TLM, and 7 patients (4%) chose RT. The most common reason for choosing TLM was shorter treatment and more treatment options in case of recurrence. Subanalysis showed that additional counseling by the radiotherapist did not seem to affect our patients’ preferences for TLM in this group.

Conclusions:

The majority of patients in our study prefer TLM to RT when given a choice. Reasons given indicate that optimizing future treatment options and practical considerations seemed more important to our patients than primary functional outcome. Further research is needed to study patient-related and physician-related factors to gain more insight into this complicated process of shared decision making.
Questions about the Medication-Related National Patient Safety Goals
Authors: Rich Darryl S.
Published: January 2018

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environment. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site. Any question is fair game.
The Training Process (Part 2)
Authors: Miller Alicia S.
Published: January 2018

This continuing feature will inform readers about the process of implementing, maintaining, and supporting computerized prescriber order entry (CPOE) at the Ohio State University Medical Center. (By “prescribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of CPOE at the Medical Center. Questions or suggestions should be addressed to Alicia S. Miller, Department of Pharmacy, The Ohio State University Medical Center, 368 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210. E-mail: miller-4@medctr.osu.edu
Determining Sources of Workplace Contamination with Antineoplastic Drugs and Comparing Conventional IV Drug Preparation with a Closed System
Authors: Spivey Susan , Connor Thomas H.
Published: January 2018

Many procedures involved in the preparation and administration of hazardous drugs put health care workers at risk of exposure to these agents through leakage or accidental spills. The first objective of this study was to determine if the conventional needle/syringe technique has the potential to allow drugs to escape into the environment. The second objective was to evaluate if a closed system, PhaSeal, prevents inadvertent release of hazardous drugs. Fluorescein, a fluorescent indicator, was prepared as a dry powder and a 0.05% solution in empty drug vials. Each phase of the manipulation was photographed using UV light to visualize fluorescein leaks and spills. The procedures included reconstitution of a dry powder, drug transfer from the vial to an IV bag, simulated drug administration, and IV push administrations through an IV port. With the conventional needle/syringe technique, each phase of the manipulations resulted in visible fluorescein leakage into the environment. Fluorescein leakage ranged in size from less than 1 to 50 mm in diameter. The syringes, work surfaces, gloves, manifold ports, and IV bag ports exhibited fluorescein contamination. With PhaSeal, no leakage was observed during any phase of the manipulations. Using the conventional needle/syringe technique during preparation of a hazardous drug may lead to release of the agent into the work environment, posing a health risk to the worker. A closed system such as PhaSeal has the ability to confine hazardous drugs, substantially reducing or possibly eliminating drug exposures.
Are Investigational Drugs Getting you Down? One Hospital's Solution to the Increasing Number of Clinical Research Studies
Authors: Sybert Christine D.
Published: January 2018

This article describes the process and results of employing an Investigational Drug Service Pharmacist (IDSP) to coordinate pharmacy support for clinical drug studies. In 1998, a Clinical Research Center (CRC) was established to coordinate all research at a 407-bed Baltimore teaching hospital, resulting in an increase in studies requiring pharmacy support. By the end of 1998, there was a backlog of nine studies awaiting review for feasibility and impact on pharmacy resources. A lack of communication between departments further impeded the process. In March 1999, a part-time pharmacist was hired to coordinate all drug studies; the pharmacist's salary was paid by the CRC. Primary responsibilities of the position were protocol review, staff education, and drug accountability. Dispensing was still handled by staff pharmacists. After three years, results were as follows: 72 studies were reviewed, 41 were opened for enrollment, 8 were in preparation, 16 were completed. Two studies alone have saved the pharmacy department over $80,000 in drug acquisition costs. The efforts of the IDSP have helped the CRC to more than double its growth, with gross income from studies of $533,712 in 2001 compared with only $237,663 in 1998. The IDSP has improved communication between the CRC and pharmacy and expedited study initiation. It has also made the CRC more attractive to prospective sponsors, since one pharmacist works directly with study coordinators. With more physicians interested in carrying out research and hospital budgets becoming tighter, the part-time IDSP position represents an important means of supporting these endeavors without increasing fiscal burdens.
Monitoring Low Molecular Weight Heparins with antiXa Activity: House of Cards or Firm Foundation?
Authors: Fraser Gilles L. , Mckenna Joe P.
Published: January 2018

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. It will review recent advances (including evolving and controversial data) in drug therapy for adult ICU patients and assess these new modalities in terms of clinical, humanistic, and economic outcomes.
Aripiprazole
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: January 2018

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 III 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. The monographs are published in printed form and on diskettes that allow customization. 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 March 2003 monograph topics are adalimumab, eletriptan, cyclosporine ophthalmic emulsion, montelukast for allergic rhinitis, and icodextrin peritoneal dialysis solution. The DUE is on adalimumab.
Look-Alike Names and Packages Are at the Root of Most Stocking Errors in Automated Dispensing Cabinets Use Caution when Reconstituting Synagis (Palivizumab) Intrathecal Vincristine Fatal Once More Fellowship in Medication Safety Medication Safety Videos Available Free via the Internet
Authors: Cohen Michael R.
Published: January 2018

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, 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.
Adverse Drug Reactions outside the Hospital Two Separate Adverse Events Caused by Clopidogrel Hepatic Failure Due to Propylthiouracil Newer Antipsychotic Agent Reported to Cause Priapism
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to 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.
Pharmacotherapy for Alcohol Withdrawal
Authors: Hodges Brian M.
Published: January 2018

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 .
Sometimes Things Get Lost in Translation New Color Code for 25 Gauge Safety Needles may Lead to Confusion and Errors New Tools that Address Pharmacy Issues Related to Patient Safety Intra-arterial Lines Can Unwittingly Furnish a Route for Medications Intended for IV Administration
Authors: Cohen Michael R.
Published: January 2018

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, 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.
Another Major Study on Adverse Events in the Ambulatory Setting Hepatotoxicity Caused by Angiotensin II Receptor Blockers Interferon Alfa Therapy and Psychosis Priapism with an Atypical Antipsychotic Update on Drug-Induced Thrombocytopenia
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to 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.
Phytonadione Education Program in a Community Hospital
Authors: Murphey Lisa M. , Byrd Debbie C.
Published: January 2018

Purpose

Pharmacists and physicians were educated regarding updated guidelines on phytonadione indications, dosing, and routes of administration. Study objectives were to evaluate the use of phytonadione in a community hospital, educate pharmacists and physicians about phytonadione use, and assess the value of education in terms of patient outcomes.

Methods

Baseline and follow-up data on phytonadione indications, dosages, and routes of administration were collected. Pretests and post-tests were administered before and after an education session. A Pharmacy and Therapeutics newsletter article highlighting the appropriate use of phytonadione was published.

Results

The baseline and follow-up medication use evaluations (MUEs) revealed that 53% and 62% of patients had an appropriate indication for phytonadione, respectively (P = 0.181). Among patients with an appropriate indication, 44% were administered an appropriate dose in the baseline group and 46% in the follow-up (P = 0.876). The baseline MUE revealed that 20% of phytonadione routes of administration were appropriate; 18% were considered appropriate in the follow-up (P = 0.842). Pharmacists' knowledge showed improvement after education efforts, with the mean score improving from 57% to 93.4% from pretest to post-test (P < 0.05) and the median score changing from 50% to 100%.

Conclusion

Improving pharmacists' knowledge is beneficial and necessary; however, it was not enough to change practice in this study. Additional steps must be taken to encourage routine application of the knowledge.
Medication Safety in the Pediatric Emergency Department
Authors: Levine Stuart , Holbrook Kay , O'connor-Pepe Barbara , Shinn Deidre
Published: January 2018

This continuing feature will focus on recent advancements in the areas of pediatrics and neonatal pharmacology and on methods for reducing medication error risk in this patient population. Most pharmacological agents are designed with the adult in mind, and there is little literature-based data from which to derive dosing schedules and proper drug administration techniques for the pediatric and neonatal patient. Moreover, pharmacological response in this group is not well understood. We hope that this feature will help you provide pharmaceutical care to this high-risk population. Direct questions or comments to Stuart Levine, PharmD, at slevine@nemours.org .
Enteral Feeding Solution Given Intravenously Zetia Confused with Zestril Proper Use of Lantus Insulin how Two Wrongs Made a Right
Authors: Cohen Michael R.
Published: January 2018

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, 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.
Psychotic Behavior Associated with Opioids in Elderly Patients Montelukast-Induced Hepatotoxicity Neuroleptic Malignant Syndrome and Low-Dose Olanzapine Visual Hallucinations with Zonisamide Thrombotic Complications Associated with IV Immunoglobulin Therapy
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to 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.
COX-2 Inhibitors: Effects on Blood Pressure in a Veterans Affairs Medical Center
Authors: Schellhase Ellen , Suryaatmaja Elizabeth , Evans Tamara S.
Published: January 2018

Background

Traditional nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with elevated blood pressure. The effect of COX-2 inhibitors on blood pressure, however, has not been well established.

Objectives

This study aimed to determine the effects of COX-2 inhibitors on blood pressure and whether these effects represented a class effect or specific drug differences.

Methods

Patients were randomly selected from a computer-generated list of all patients actively taking a COX-2 inhibitor as of July 2001; electronic and paper medical records for these patients were retrospectively reviewed. Data collection included patient demographics, medication history, and blood pressure measurements.

Results

A total of 75 patients receiving rofecoxib and 25 patients receiving celecoxib were evaluated. After initiation of rofecoxib therapy, average systolic blood pressure increased from 131.4 ± 13.1 mmHg to 135.7 ± 17.4 mmHg (P = 0.012). Patients started on celecoxib demonstrated an average systolic blood pressure decrease, from 136.3 ± 23 mmHg to 129.6 ± 21.9 mmHg (P = 0.042). No statistically significant changes in diastolic blood pressure were observed. No change in systolic blood pressure was observed in 16 celecoxib-treated patients (64%) and 29 rofecoxib-treated patients (38.7%). A total of 8 patients (8%) (1 celecoxibtreated and 7 rofecoxib-treated) experienced increases in systolic blood pressure greater than 20 mmHg during therapy.

Conclusion

Blood pressure changes may be unique for each COX-2 inhibitor agent and not the result of a class effect. Blood pressure should be monitored in all patients receiving COX-2 inhibitors. Additional prospective studies that assess the effect of COX-2 inhibitors on cardiovascular outcomes should be conducted.
Journal Clubs Managed Care Pharmacy Ethics
Authors: Generali Joyce A.
Published: January 2018

To help readers monitor the most important developments in specialized areas of pharmacy practice in organized health systems, Hospital Pharmacy commissions Basic Bibliographies by guest editors, who have expertise in their respective fields. These guest editors survey the relevant literature and rank approximately 15 to 20 references that represent the most significant research and practice contributions in their areas. The more fundamental are listed first so that persons with limited time can select reading appropriate to their needs. A cumulative index to Basic Bibliography topics will be published semiannually in June and December.
Downtime Procedures (Part 2)
Authors: Miller Alicia S.
Published: January 2018

This continuing feature will inform readers about the process of implementing, maintaining, and supporting computerized prescriber order entry (CPOE) at the Ohio State University Medical Center. (By “prescribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of CPOE at the Medical Center.
Ephedrine–Epinephrine Mix-Ups Nurse Computer Order Entry Leads to Error Precisely Wrong
Authors: Cohen Michael R.
Published: January 2018

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, 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.
Shock-Like Sensations Associated with Antidepressant Withdrawal Acute Tumor Lysis Syndrome Caused by Hydroxyurea Zolpidem-Induced Visual Hallucinations Tooth Discoloration with Linezolid Sleepwalking Caused by SSRI ADR-Related Reports from the Archives of Internal Medicine
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to 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.
Bortezomib Gefitinib
Authors: Solimando Dominic A. , Waddell J. Aubrey
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases and reviews issues related to the preparation, dispensing, and administration of cancer chemotherapy.