bluuebunny/crossref_metadata_2025 huggingface dataset:
The Risk of Sedation/Analgesia in Hemodialysis Patients Undergoing Interventional Procedures
Authors: Beathard Gerald A. , Urbanes Aris , Litchfield Terry , Weinstein Alex
Published: February 2011

Data derived from a large cohort of hemodialysis patients (12,896) undergoing dialysis access maintenance procedures being performed by interventional nephrologists were analyzed to determine the safety of sedation/analgesia (S/A) in a freestanding facility. Data collected included patient demographics, procedures performed, time of procedures, drugs used, doses used, and complications that occurred. Four high‐risk groups were identified based upon age, pulmonary status, and over all physical status. These were compared to the total cohort. Midazolam, fentanyl, or a combination of the two were used. Within the total cohort of patients, midazolam alone was used most commonly (94.7%). The total mean dose of midazolam when used alone was 3.4 mg. The dosages used in the high‐risk groups tended to be only slightly lower (3–3.2 mg). This setting appears to be safe for hemodialysis patients, even those in high‐risk subgroups having these types of procedures. The types of drugs and the dosages that are commonly used do not appear to be associated with an unacceptable risk to the hemodialysis patient. A nephrologist that is not specialty trained in anesthesia is able to provide S/A safely in a freestanding facility.
Near‐Intrinsic Grain‐Boundary Mobility in Dense Yttria
Authors: Ma Shuailei , Harmer Martin P.
Published: February 2011

Grain‐boundary mobilities and grain growth activation energies were measured on high‐purity and dense yttria samples annealed in both air and 5%H2–N2 at temperatures ranging from 1200° to 1900°C. The grain‐boundary mobility for samples annealed in 5%H2–N2 was higher in comparison with air‐annealed materials. The measured grain growth activation energy for samples annealed in air was 356 ± 35 kJ/mol. For samples annealed in 5%H2–N2, a transition temperature of 1579°C was identified where the grain growth activation energy changed dramatically. The measured activation energies were 373 ± 60 and 770 ± 2 kJ/mol for samples annealed at temperatures below and above 1579°C, respectively. The increase in activation energy was tentatively attributed to a reduction‐induced disordering of the grain boundary corresponding to the temperature at which yttrium metal liquid forms at low oxygen pressures. The data represent the best attempt to measure the near‐intrinsic grain‐boundary mobility for high‐purity highly dense yttria. High‐resolution transmission electron microscopyand high‐angle annular dark field‐scanning transmission electron microscopy confirmed that the grain boundaries were clean and free of any observable second phases.
Photoluminescence of Mn2+ Centers in Chalcohalide Glasses
Authors: Yan Qiqi , Liu Yinyao , Chen Guorong , Da Ning , Wondraczek Lothar
Published: February 2011

We report on photoluminescence from Mn2+‐doped chalcohalide glasses of the GeS2–Ga2S3–CsCl system. Upon blue excitation at 447 nm, a broad emission band occurs in the green spectral range from 500 to 600 nm, indicating the presence of tetrahedrally coordinated Mn2+ species. When the Mn2+‐concentration is increased up to 2 mol%, an increasingly intense secondary emission band evolves at about 610–660 nm. Meanwhile, the intensity of the green band decreases gradually and shifts toward the red, resulting a very flatten luminescence from 500 to 750 nm, which provides a promising white light emitting source. As for the origin of this unique luminescence behavior of Mn2+, it is proposed that the ligand coordination number of Mn2+ in the present chalcohalide glasses experiences a partial change from tetrahedral to octahedral coordination.
Genetic relationships among pumpkinseed (Lepomis gibbosus) ecomorphs in freshwater reservoirs of Portugal
Authors: Bhagat Yakuta , Wilson Chris C. , Fox Michael G. , Ferreira M. Teresa
Published: February 2011

Abstract –  High levels of morphological differentiation have been found among pumpkinseeds (Lepomis gibbosus) occupying four habitat types in Portuguese reservoirs. To investigate the underlying mechanism behind the phenotypic differentiation among ecomorphs, we used six microsatellite markers to assess patterns of genetic differentiation among and within eight naturalised reservoir populations. Greater genetic differentiation was seen among reservoir populations than within reservoirs (FST > 0.041, P < 0.002). structure analysis revealed the presence of two distinct genetic groups among the set of eight reservoir populations. However, an analysis of co‐occurring forms that were identified a priori by their respective habitats was consistent with a single panmictic group, suggesting that morphological differentiation has arisen in sympatry (i.e., within a reservoir, postintroduction). The observed relationships within and among reservoir populations, combined with the timeframe of ecomorph divergence, suggest the strong likelihood of phenotypic plasticity as the underlying mechanism of diversification in the introduced pumpkinseed.
Relationship between the echogenicity of subcutaneous tissue and the depth of forehead wrinkles
Authors: Tsukahara Kazue , Osanai Osamu , Hotta Mitsuyuki , Sano Tomohiko , Kitahara Takashi , Takema Yoshinori , Tsujimoto Fumio
Published: February 2011

Background/purpose: Subcutaneous tissue is rarely studied in research on wrinkles. We used diagnostic ultrasonography to produce images of subcutaneous tissue of the forehead, one of the areas where age‐related wrinkles form. We quantified the resulting echogenicity and investigated its relationship with wrinkle depth.

Methods: One hundred and seventy‐three Japanese subjects were divided into four age groups (21–28 years, 35–41 years, 47–59 years, 65–75 years). Maximum wrinkle depth (Rmax) was measured in the forehead. On an ultrasound image, which was captured by scanning perpendicular to the deepest wrinkle, we set a 12.5‐mm‐wide region of interest by aligning the deepest point of the wrinkle at its center and then obtained the ratio of the area exceeding this threshold to the total area as the echogenicity.

Results: R
max increased and the echogenicity decreased with age. A negative correlation was found in the oldest group but was not found in other groups, presumably due to individual differences in the echogenicity among younger subjects.

Conclusion: This study suggests that the internal structure of subcutaneous tissue, as observed by ultrasonography, is related to wrinkle depth. The relationship between wrinkle depth and echogenicity of subcutaneous tissue is particularly pronounced in the elderly.
Ten‐year quality assurance of the nationwide hearing screening programme in Dutch neonatal intensive care units
Authors: van Dommelen P , van Straaten HLM , Verkerk PH ,   the Dutch NICU Neonatal Hearing Screening Working Group
Published: February 2011

Aim:  To evaluate 10‐year quality assurance of newborn hearing screening (NHS) in Dutch neonatal intensive care units (NICU).

Methods:  Results of the two‐stage automated auditory brainstem response (AABR) screening and diagnostic examination in NICU graduates were centrally registered between October 1998 and December 2008. This registration facilitates screening, tracking and follow‐up after abnormal screening results. Outcome measures are referral rates, prevalence rate of hearing loss and (trends of) coverage rates and timeliness of follow‐up.

Results:  Thirty‐two thousand one hundred and two infants have been screened. Referral rates were 9.2% at the first and 26.3% at the second stage. Hearing loss was diagnosed in 728 infants (2.2%). Coverage rates were 98.7% at the first, 92.1% at the second stage, 92.3% for the diagnostic examination and 97.9% for the complete programme. After correction for gestational age, 95.8% of the infants had their first AABR <1 month, 81.8% of the referred infants had their second AABR <6 weeks and 67.1% were diagnosed <3 months. There was a positive trend in referred infants that had their second AABR <6 weeks (p = 0.004) as well as in infants diagnosed <3 months (p < 0.001).

Conclusion:  The NHS in Dutch NICUs is effective. Timely identification of hearing loss is improving over time.
Oligomannose‐coated liposomes efficiently induce human T‐cell leukemia virus‐1‐specific cytotoxic T lymphocytes without adjuvant
Authors: Kozako Tomohiro , Hirata Shinya , Shimizu Yoshitaka , Satoh Yuichiro , Yoshimitsu Makoto , White Yohann , Lemonnier François , Shimeno Hiroshi , Soeda Shinji , Arima Naomichi
Published: February 2011

Human T‐cell leukemia virus‐1 (HTLV‐1) causes adult T‐cell leukemia/lymphoma, which is an aggressive peripheral T‐cell neoplasm. Insufficient T‐cell response to HTLV‐1 is a potential risk factor in adult T‐cell leukemia/lymphoma. Efficient induction of antigen‐specific cytotoxic T lymphocytes is important for immunological suppression of virus‐infected cell proliferation and oncogenesis, but efficient induction of antigen‐specific cytotoxic T lymphocytes has evaded strategies utilizing poorly immunogenic free synthetic peptides. Here, we examined the efficient induction of an HTLV‐1‐specific CD8+ T‐cell response by oligomannose‐coated liposomes (OMLs) encapsulating the human leukocyte antigen (HLA)‐A*0201‐restricted HTLV‐1 Tax‐epitope (OML/Tax). Immunization of HLA‐A*0201 transgenic mice with OML/Tax induced an HTLV‐1‐specific gamma‐interferon reaction, whereas immunization with epitope peptide alone induced no reaction. Upon exposure of dendritic cells to OML/Tax, the levels of CD86, major histocompatibility complex class I, HLA‐A02 and major histocompatibility complex class II expression were increased. In addition, our results showed that HTLV‐1‐specific CD8+ T cells can be efficiently induced by OML/Tax from HTLV‐1 carriers compared with epitope peptide alone, and these HTLV‐1‐specific CD8+ T cells were able to lyse cells presenting the peptide. These results suggest that OML/Tax is capable of inducing antigen‐specific cellular immune responses without adjuvants and may be useful as an effective vaccine carrier for prophylaxis in tumors and infectious diseases by substituting the epitope peptide.
Retracted: Kinetics of Formation for Lanthanide (III) Complexes of DTPA‐(Me‐Trp)2 used as Imaging Agent
Authors: Tiwari Anjani K. , Sinha Deepa , Datta Anupama , Kakkar Dipti , Mishra Anil K.
Published: February 2011

Diethlenetriamine‐N,N,N′N′′N′′‐pentaacetic acid (DTPA)‐bis (amide) analogs have been synthesized and evaluated as a potential biomedical imaging agents. Imaging and biodistribution studies were performed in mice that showed a significant accumulation of DTPA analogs in brain. The stability and protonation constants of the complexes formed between the ligand [DTPA‐(Me‐Trp)2] and Gd3+, Eu3+, and Cu2+ have been determined by pH potentiometry (Gd3+, Eu3+) and spectrophotometry (Cu2+) at 25 °C and at constant ionic strength maintained by 0.10 m KCl. The kinetic inertness of Gd [DTPA‐(Me‐Trp)2] was characterized by the rates of exchange reactions with Zn2+ and Eu3+. In the Eu3+ exchange, a second‐order [H+] dependence was found for the pseudo‐first‐order rate constant [k0 = (4.5 ± 1.2) × 10−6/s; k1 = 0.58 ± 0.1 /m/s, k2 = (6.6 ± 0.2) × 104 /m2/s, k3 = (4.8 ± 0.8) × 10−4/m/s]. In the Eu3+ exchange, at pH <5.0, the rate decreases with increasing concentration of the exchanging ion. At physiological pH, the kinetic inertness of [DTPA‐(Me‐Trp)2] is more inert than GdDTPA2−, the most commonly used MRI contrast agent (t1/2 = 127 h). High kinetic stability is an important requirement for the Gd complexes used as contrast enhancement agents in magnetic resonance imaging.
In Vitro Inhibition of Human Carbonic Anhydrase I and II Isozymes with Natural Phenolic Compounds
Authors: Şentürk Murat , Gülçin İlhami , Beydemir Şükrü , Küfrevioğlu Ö. İrfan , Supuran Claudiu T.
Published: February 2011

Inhibition of two human cytosolic carbonic anhydrase (hCA, EC 4.2.1.1) isozymes I and II with some natural phenolic derivatives was investigated using the esterase assay with 4‐nitrophenyl acetate as substrate. Resveratrol, catechin, silymarin, dobutamin, and curcumin showed KI values in the range of 4.47–9.47 mm for hCA I and of 2.86–7.44 μm against hCA II, respectively. These natural product phenols were generally competitive inhibitors with 4‐nitrophenylacetate as substrate. Some natural phenols investigated here showed effective hCA II inhibitory effects, in the same range as the clinically used sulfonamide acetazolamide, and might be used as leads for generating enzyme inhibitors possibly targeting other CA isoforms that have not been yet assayed for their interactions with such agents.
Ethosuximide and Phenobarbital Promote Wound Healing via Enhancing Collagenization
Authors: Ajwee Dema M. , Disi Ahmad M. , Qunaibi Eyad A. , Taha Mutasem O.
Published: February 2011

The fact that ethosuximide (ETO), phenobarbital (PHO), and barbituric acid (BARB) share structural and pharmacophoric homologies with phenytoin and allantoin, both known to have significant wound‐healing properties, prompted us to evaluate them as wound‐healing agents. Accordingly, ETO‐, PHO‐, and BARB‐containing ointments were applied onto full‐thickness excision and incision wounds created on the dorso‐lumbar region of experimental rats. ETO‐and PHO‐treated incision wounds illustrated significant enhancement in breaking strengths (1380 ± 61 and 1240 ± 42 g, respectively) compared to vehicle controls (1070 ± 18 g) and BARB (1080 ± 45 g). Moreover, biochemical analyses revealed significant increase in hydroxyproline contents in ETO‐ and PHO‐treated wounds compared to vehicle controls. Histological evaluation revealed that both ETO and PHO promoted collagen synthesis and deposition. This is the first time to describe the significant wound‐healing merits of ETO and PHO as potential clinical agents for treatment of chronic wounds.
Citizenship at the Margins: The Canadian Seasonal Agricultural Worker Program and Civil Society Advocacy
Authors: GABRIEL CHRISTINA , MACDONALD LAURA
Published: February 2011

This article evaluates the role civil society organizations play in helping noncitizen migrant workers access to social rights in Canada. The study focuses on the bilateral Canadian Seasonal Agricultural Workers Program, a temporary worker scheme that brings Mexicans to Canada to work as harvesters for a four‐to‐eight‐month period. Despite the common description of this program as “best practice,” questions are raised about the ability of workers to access citizenship rights and even limited labor protections. We draw on primary field research conducted in the province of Ontario's agricultural sector to consider how involvement of civil society state actors operating at a variety of scales—local, national, international, and the extra territorial—in a range of social justice struggles expands access to social citizenship rights for Mexican migrant workers.

Este artículo evalúa el rol que juegan las organizaciones de la sociedad civil en la ayuda a los trabajadores migrantes no‐ciudadanos en el acceso a derechos sociales en Canadá. El estudio se enfoca en el Programa Bilateral Canadiense de Trabajadores Agrícolas Temporales (SAWP, por sus siglas en inglés), un esquema de trabajo temporal que lleva mexicanos a Canadá a trabajar como segadores por un periodo de entre cuatro y ocho meses. A pesar de la descripción de este programa como de una “buena política/práctica,” surgen preguntas acerca de la habilidad de los trabajadores de acceder a derechos ciudadanos y hasta de protección laboral limitada. Analizamos a partir de una investigación primaria conducida en el sector agrícola de la provincia de Ontario, considerar cómo la participación de actores estatales de la sociedad civil en una variedad de niveles—local, nacional, internacional y extraterritorial—en el ámbito de la justicia social amplía el acceso de los trabajadores migrantres mexicanos a los derechos sociales.
The microbiology of urban UK floodwaters and a quantitative microbial risk assessment of flooding and gastrointestinal illness
Authors: Fewtrell L. , Kay D. , Watkins J. , Davies C. , Francis C.
Published: February 2011

A quantitative microbial risk assessment of flooding and gastrointestinal illness was carried out using a combination of floodwater quality data from the existing literature on pathogen concentrations in the various floodwater components, the use of microcosms to determine pathogen die‐off rates in floodwaters and opportunistic sampling of actual UK floodwaters. Two flood‐related scenarios were examined in a hypothetical population to provide an assessment of the likely cases of gastrointestinal illness resulting from contact with floodwater. The results of the study suggest that significant numbers of people are at risk of illness (especially from viral gastroenteritis) during the clean‐up process rather than during the inundation and withdrawal phases. Additional sampling during flood events of water and sediment would strengthen the empirical policy evidence base required for estimating the severity and range of health impacts using the risk assessment methodology developed in this paper.
Evaluating a new LISFLOOD‐FP formulation with data from the summer 2007 floods in Tewkesbury, UK
Authors: Neal J. , Schumann G. , Fewtrell T. , Budimir M. , Bates P. , Mason D.
Published: February 2011

Two‐dimensional flood inundation modelling is a widely used tool to aid flood risk management. In urban areas, the model spatial resolution required to represent flows through a typical street network often results in an impractical computational cost at the city scale. This paper presents the calibration and evaluation of a recently developed formulation of the LISFLOOD‐FP model, which is more computationally efficient at these resolutions. Aerial photography was available for model evaluation on 3 days from the 24 to the 31 of July. The new formulation was benchmarked against the original version of the model at 20 and 40 m resolutions, demonstrating equally accurate simulation, given the evaluation data but at a 67 times faster computation time. The July event was then simulated at the 2 m resolution of the available airborne LiDAR DEM. This resulted in more accurate simulation of the floodplain drying dynamics compared with the coarse resolution models, although maximum inundation levels were simulated equally well at all resolutions tested.
Evolution of hepatic fibrosis research
Authors: Kawada Norifumi
Published: February 2011

Molecular analysis of hepatic fibrogenesis has progressed with respect to both fibrosis progression and regression by using cell biological, molecular biological and (epi)genetic approaches. Recent researches have revealed sources of collagen‐producing cells other than hepatic stellate cells in the liver, and the involvement of the innate immune system and oxidative stress in the fibrotic process has attracted new attention. Together with these advancements in basic knowledge on the cellular and molecular biology of hepatic fibrosis, clinical researches have linked the clarification of the relationship between progression of the fibrosis stage and therapeutic efficacy for chronic viral hepatitis and non‐alcoholic steatohepatitis and validation of the regression of advanced fibrosis, even cirrhosis, of appropriate therapies using modern medicines. Furthermore, non‐invasive assessment of liver fibrosis using an ultrasound‐based modality has become a focus in the clinical diagnosis of liver fibrosis instead of liver biopsy. Taken together, liver fibrosis research has been evolving both basically and clinically in the past three decades.
Influence of patient age on drug costs: An investigation to validate the prescribing unit
Authors: Edwards C , Metcalfe D , Burr A , Watson K , Steward F C N , Jepson M H , van Zwanenberg T D
Published: February 2011

The costs of 15,226 drug items prescribed by 22 doctors in two UK health centres were analysed with respect to patients' age and gender. For patients aged 65 and over, average drug costs per practice patient at the health centres were, respectively, 3.6 and 5.2 times greater, and the number of prescribed items 3.3 and 5.6 times greater, than for patients under 65. When analysed in 10 patient-age bands, there was a gradual increase in the number of prescribed items and average costs from the age of 35 to 74 years at each centre. Items and costs decreased for patients aged 75 and over. The increase in costs was the consequence of a general increase in prescribed items throughout the major therapeutic groups. The findings suggest that the prescribing unit, which is a weighting factor for age currently employed to standardise populations when making interpractice comparisons of prescribing costs, may not be wholly appropriate and could conceal important differences in some patient groups, especially the middle age ranges of 35 to 64 years.
Professional values and pharmacy practice: Keywords and concepts
Authors: Brown M E , Ellis S , Linley P A , Booth T G
Published: February 2011

A range of factors was established, such as knowledge and ethics, which underlay the practice of six groups of health professionals: pharmacists, dentists, doctors, nurses, optometrists and radiographers. These factors have been identified as “concepts”. The method used was content analysis of official documents of the professions, such as codes of ethics and guidance documents. Postal questionnaires were also used to collect data. Nine principal concepts were identified. A “collective professional consciousness” was evident, in which knowledge, patient welfare and ethics were important concepts for the highest quality of practice. The perceived importance of these and other concepts was broadly similar across the professions.
In vitro assessment of ampicillin capsules marketed in Nigeria
Authors: Iwuagwu M A , Onyeonwu N
Published: February 2011

An in vitro characterisation of thirteen brands of 250mg ampicillin capsules available in Nigeria was carried out. Nearly a quarter (3; 23.1 per cent) of the brands tested were substandard. Two brands, one from England, failed the BP identification test for ampicillin and were classed as fakes. Eleven brands passed the BP uniformity of weight and disintegration tests, but only 10 brands passed both the BP content uniformity test and the BP dissolution rate test. Similar dissolution profiles for three brands of ampicillin capsules were obtained with three different pieces of equipment — the BP apparatus, Levy's beaker apparatus and a stationary basket/magnetic stirrer apparatus. The results emphasise the need for routine quality assurance testing of pharmaceuticals before dispensing to patients. The stationary basket/magnetic stirrer dissolution test has the advantage of simplicity and low cost.
Patient counselling: an investigation of core situations and difficulties in pharmacy practice
Authors: Morrow Norman , Morrow Owen
Published: February 2011

Within the past five years there has been a growth of interest in the application of communication skills training (CST) programmes to pharmacy. The content of these programmes has been based primarily on research carried out in other health professions. There is a clear need for similar research to be set in the context of pharmacy so that the content of CST programmes can be shown to be directly relevant and applicable to practice needs. The purpose of this investigation was to ascertain from pharmacists their perceptions of the range of situations and difficulties that were most relevant to patient counselling. The situation which was regarded as being most prevalent was that of dealing with confusion over medication, with the second being that of medication problems in the elderly. The two most frequently mentioned counselling difficulties were having sufficient time to deal with patients and ensuring patient understanding. The findings are discussed within the context of the design and content of CST programmes, and the wider application of the behavioural and social sciences to the practice of pharmacy.
Ageing of intravenous glucose solutions
Authors: Hecker J , Lewis G B H
Published: February 2011

The pH and acid content of 63 glucose-based solutions was measured up to eight years after their expiry. The pH ranged from 2.27 to 4.33. Newly manufactured solutions with 5 per cent or less of glucose which were packaged in plastic bags contained in the order of 0.01 mEq/L of acid per gram of glucose. Solutions with higher glucose concentrations had lower pH and greater acid. As solutions in bags became older, pH decreased and acid increased. In contrast, 25 per cent and 50 per cent glucose solutions in glass containers were much less acid and showed only slight changes with age in pH or acid. The greater rate of acid increase in glucose solutions in plastic bags may be due to the bags being permeable to oxygen and thus allowing slow oxidation of the glucose.
Audit of a laxative policy for elderly patients
Authors: Goodyer L I , Fahey M , Tristram J
Published: February 2011

A laxative policy was introduced at Charing Cross hospital, London, which recommended co-danthrusate and co-danthramer as first line treatment for constipation in the elderly. As a result of this policy the prescribing of lactulose was virtually eliminated and the use of phosphate enemas fell significantly.
Changing the method of maintaining patency of indwelling intravenous catheters: A pharmacy initiative
Authors: Fitzpatrick R W
Published: February 2011

Low concentration heparin solutions are used routinely in many hospitals to maintain the patency of indwelling peripheral venous catheters. This practice poses potential problems, as well as having a cost implication for the drugs budget. In view of evidence suggesting normal saline as an effective alternative, the pharmaceutical service in North Staffordshire health district initiated a programme to encourage the use of saline in preference to heparin for maintaining catheter patency. This paper describes the strategies used to achieve a change in practice, and demonstrates the success of the programme. The cumulative savings on the drugs budget in the three years following the change exceeded £15,000
Pharmacokinetics and dose requirements of disopyramide in neonates and children
Authors: Thomson A H , Mcgovern E M , Caldwell G
Published: February 2011

The pharmacokinetics and dose requirements of disopyramide were evaluated in 10 infants and children during the course of routine therapeutic drug monitoring. Drug clearance was estimated using a Bayesian parameter estimation program and found to range from 0.09-0.31L/h/kg. Concentrations associated with a satisfactory response were achieved with doses of 15-20mg/kg/day in most patients, but some required higher doses of 25-30mg/kg/day.
Good quality pharmaceutical care — implications for carers with elderly dependants
Authors: Goldstein Ruth , Rivers Peter , Close Paul
Published: February 2011

Elderly people are often dependent on carers, both informal and formal. This article reviews the role of carers and discusses their involvement in the administration of medicines.
Management of steroid reducing regimens by patients
Authors: Mason J S , Walker Roger
Published: February 2011

Patient management of solid oral dosage steroid reducing courses was studied over a 20-week period at North Tees General hospital. Seventy-five eligible patients were identified, of whom 57 were recruited and subsequently interviewed at home towards the end of their reducing dosage programme.

Tablet count was used to assess compliance in 50 patients. Thirty-seven patients (74 per cent) were found to be compliant. Patients whose present courses of steroid treatment were of more than six months' duration and those who had undertaken eight or more reducing dosage courses during the previous two years were less compliant than others. Thirty-six (65 per cent) of 55 patients on once-daily regimens regularly took their medication within two hours of 8am. Five patients (9 per cent) inappropriately divided their daily dosages.

Although compliance was assessed as being good, possibilities exist for effecting improvement.
The role of the community pharmacist — a survey of public opinion in Northern Ireland
Authors: McElnay J C , Nicholl A J , Grainger-Rousseau T-J
Published: February 2011

Data from a survey of 906 members of the public (570 females, 336 males; age range 13–90 years) with regard to opinions on, and use of present and proposed community pharmacy services are presented. It was shown that the majority of people (67.7 per cent) visit pharmacies at least once a month. Females visit pharmacies more frequently than males (P<0.05). Respondents who were less than 25 years old were more likely than older age groups to purchase non-prescription medicines from pharmacies although they were less likely to use the same pharmacy (P<0.05). Proximity to a person's home was the major deciding factor for patronising a particular pharmacy (43.7 per cent). The major factor determining choice of non-prescription medicines was previous use (34.7 per cent), with pharmacist's advice (29.3 per cent) the second most frequent response. For a range of common minor ailments, respondents were more likely to seek their doctor's advice or self-treat the condition than seek advice from the pharmacist. With respect to extended role activities, 93.4 per cent felt that the pharmacist had a role to play in health education, the provision of individualised advice being the most frequently noted method for this (34.6 per cent). Health screening services were highly supported (90.6 per cent), as was the maintenance of patient medication records (93.6 per cent). A greater proportion of the younger age group (<25 years old) than the older age groups supported the provision of health screening services (P<0.05). In response to a question on services that the public would like to see provided by community pharmacists, the most popular responses were: giving more advice on the treatment of minor ailments and the provision of a private consultation area within the pharmacy. Overall, the results show a positive response to the current and future use of community based pharmaceutical services.
Self-medication by patients presenting to an ophthalmic casualty department
Authors: Hardy N , Hodgkins P , Luff A , Elkington A
Published: February 2011

This study examines the outcome of a period of self-medication prior to presentation at an ophthalmic casualty department. One hundred patients who had self-medicated completed a questionnaire at the time of presentation. Eleven different products/brands were used in self-medication, the most popular being Brolene drops or ointment (n = 55). Forty-five patients had sought advice from a community pharmacist, eight from a nurse and four from an optometrist. Forty-three patients had taken no professional advice. The period of self-medication was judged by an ophthalmologist to be insignificant in 73 of the cases, beneficial in four and detrimental in 23. Of the 23 cases judged “detrimental”, self-medication was considered in 19 cases to have delayed the treatment of a painful condition, and in four cases to have potentially threatened the visual outcome.
An investigation into patient compliance with hospital discharge medication in a local population
Authors: Eagleton Julie M , Walker Fiona S , Barber Nicholas D
Published: February 2011

Compliance with prescribed drug treatment within two weeks of discharge from hospital was studied in 50 patients discharged from acute medical wards. Patient knowledge about medicines and factors influencing compliance were investigated. A combination of tablet counts and questionnaires was used. Eleven patients were found to have deviated from the prescribed regimen. The prescribing of complex drug regimens appeared to be one of the factors affecting non-compliance. Patient knowledge about their medicines was generally poor, with less than one quarter knowing the names and purposes of all their medicines, and 70 per cent not knowing about any single side effect their medicines could cause. No correlation was found between poor knowledge and non-compliance. The attitudinal questionnaire used was not helpful in identifying non-compliers.
Iatrogenic bismuth toxicity associated with inadvertent long term De-Noltab ingestion
Authors: Ching C K , Long R G , O'Hara R , Richardson J
Published: February 2011

A prolonged course of oral tripotassium dicitratobismuthate (De-Noltab) was administered to an elderly woman. The patient developed extrapyramidal neurological symptoms and subsequently sustained accidental fracture of the right neck of the femur before bismuth toxicity was identified. The parkinsonian features that presented in this patient were thought to be possibly related to the accumulation of bismuth in the basal ganglia as a result of the long term ingestion of tripotassium dicitratobismuthate.

Prolonged treatment with the drug should be discouraged and repeat prescriptions should always be queried.
A multicentre study of dispensing errors in British hospitals
Authors: Spencer Michael G , Smith Andrew P
Published: February 2011

Nineteen hospital pharmacies in Britain participated in a study of dispensing errors. All dispensing errors (errors detected outside the department) and a sample of dispensing incidents (errors detected as part of the checking process) were recorded using a standard data collection form over a period of six months. One hundred and seventy-eight errors and 1,500 incidents were analysed. The overall error rate was 18.1/100,000 dispensed items (range 2.9–49.1/100,000). The mean error rate was 11.5/100,000 items in hospitals where all dispensing is checked and 35/100,000 items in hospitals where only items dispensed by non-pharmacists are checked. There were also differences in type between errors and incidents −31.7 per cent of incidents involved incorrect directions on the label compared with 17.4 per cent of errors; 34.2 per cent of incidents involved the wrong drug or drug strength being dispensed compared with 45.5 per cent of errors. One hundred and forty-five different drugs were involved in the 178 errors, with three drugs being involved in six errors each (flucloxacillin, glyceryl trinitrate and frusemide). The results of this study can contribute to the preparation of risk management strategies for dispensing.
Effect of Replens vaginal moisturiser on latex rubber condoms: a comparison with oil and water based preparations
Authors: Lee M G , Morris P
Published: February 2011

The effect of Replens vaginal moisturiser on the tensile properties of latex rubber condoms was compared with that of baby oil, K-Y jelly, Nystan cream and Duracreme. The tensile strength and elongation at break of test pieces cut from condoms were measured after immersion in each of the test products for five minutes. The tensile properties of the latex was unaffected after treatment with Replens. K-Y jelly, Duracreme and Replens produced similar results.
Patient acceptability of cyclical etidronate and calcium therapy and symptomatic response to treatment
Authors: Curle A J , Cantrill J A
Published: February 2011

One hundred and seventeen patients (75 per cent women) with established osteoporosis were entered into a clinical trial assessing two regimes of cyclical etidronate and calcium (Cacit). Some subjective parameters of clinical outcome were assessed prior to, and during, treatment. Patient acceptability of therapy was also examined.

There was a significant reduction in pain score (median scores from a 10-point visual analogue scale at 0, 6–12 and 15–24 months were 4, 2 and 1, respectively) and in analgesic consumption (32 per cent, 51 per cent and 65 per cent of patients at 0, 6–12 and 15–24 months, respectively, were using no analgesics). Sleeping patterns improved significantly during the study but there was no change in hypnotic consumption. Sixty-four per cent of patients felt there had been an improvement in their condition and 79 per cent felt that attending the clinic had helped them come to terms with osteoporosis.

Etidronate was well tolerated: 23 per cent of patients experienced mild gastrointestinal side effects; 94 per cent were prepared to continue with treatment indefinitely. However, 43 per cent felt their daily routine was interrupted by taking etidronate. The Cacit was poorly tolerated: 50 per cent of patients experienced gastrointestinal side effects, 28 per cent had to discontinue calcium because of side effects and 24 per cent felt their daily routine was altered by taking calcium. Eighty-five per cent were, however, prepared to continue with some form of calcium supplement indefinitely.

In conclusion, etidronate therapy was an acceptable form of treatment in this group of patients and provided some symptomatic improvement. However, the choice of calcium supplement was less acceptable and may lead to non-compliance with treatment.
Placebo effect: its role in adherence, treatment effectiveness and patient outcomes
Authors: Tucker Patricia P , Wertheimer Albert I
Published: February 2011

Research on the placebo effect and its hypothetical relationship to adherence and improved patient outcomes is reviewed. Future research for pharmacists is highlighted. Clinicians and researchers have alternately attempted to suppress, control for and maximise the placebo response. Much research has been conducted to identify the placebo responder. The placebo response is seldom uniform, constant or predictable, and neither sex, age, intelligence, ethnic, cultural or social factors are predictive of it. However, no research has investigated the relationship of adherence, placebo effects and patient outcomes. Adherence to therapy and its role in activating the placebo response is described. Efforts to increase adherence may increase treatment effectiveness by activating the placebo response. The pharmacist may be in an ideal position to better understand the placebo effect and its role in enhancing patient outcomes. The placebo effect, thus, may be a useful part of the care giver's armamentarium.
Factors associated with the prescribing of extemporaneous preparations in Sweden
Authors: Lindblad Åsa Kettis , Isacson DAG
Published: February 2011

Extemporaneous preparations are drugs that are compounded for individual patients or made in larger batches for stock-keeping. This study aimed to analyse factors associated with the prescribing of such preparations in Sweden.

Information was taken from the Swedish diagnosis and therapy survey for the time period October, 1986, to September, 1988, inclusive. This survey collects from a random sample of doctors the details of all prescriptions they write during one week, as well as all corresponding diagnoses. The present study analysed extemporaneous prescriptions and the characteristics of doctors issuing them.

Of the 2,142 doctors who contributed prescriptions to the survey, 19 per cent wrote at least one prescription for an extemporaneous preparation. Young patients obtained such preparations more than older patients. Proportionately fewer of the youngest doctors prescribed them. Dermatologists prescribed extemporaneous preparations much more commonly than other doctors, and most of the preparations concerned were dermatologicals. The most common diagnosis for the prescribing of these preparations was contact eczema, with psoriasis second. The findings suggest that the prescribing of extemporaneous preparations is established and continuing and not just a feature of obsolete practice. However, the appropriateness of these products should be further analysed and assessed to ensure that they are clinically and pharmaceutically safe and effective.
Application of a formal prescription monitoring service to community pharmacy
Authors: Donaldson S M , Radley A S , Kendall H E
Published: February 2011

A three-month study in a suburban health centre pharmacy investigated whether a clinical pharmacy service could be carried out in the community setting. Each week, all the prescriptions from the three general practitioners in one of the health centre's six practices were monitored. After referral to the patients' medical notes, the pharmacist identified the prescriptions that required discussion with the prescriber. The outcome of these prescription interventions was recorded. A one-month follow up study was carried out after the initial study period. Level 3 PACT data were consulted to establish changes in prescribing patterns and cost savings. During the three-month study period, 5,162 items were monitored. A total of 354 interventions were made, of which 216 (61 per cent) were accepted by the doctors and resulted in the prescription being changed. During the follow-up study, 2,462 items were monitored and 82 interventions made.

The most important outcomes of the study were that the service encouraged discussion between the pharmacist and GPs about clinical problems, and that it provided an opportunity for pharmaceutical skills positively to influence patient care. All three GPs said they would like to see the clinical service provided on a long term basis and thought it should be funded by the local family health services authority. There was also a fall in costs, although this was not analysed statistically; the practice's prescribing costs were 9 per cent below the local FHSA average for the study period and 8 per cent below the FHSA average the following quarter. Prior to the study they had been 2 per cent above the local FHSA average.
How do pharmacy staff perceive customers who receive an antibiotic?
Authors: Lilja John , Larsson Sam
Published: February 2011

The aim of this study was to analyse how two groups of pharmacy staff, one Finnish and one Swedish, perceived video-taped customers who were receiving prescribed antibiotics. The study was based on a model derived from cognitive and interactional psychology.

Customers who were presumed to want more extensive drug and health information tended to be regarded as more compliant than other customers. “Independent” customers tended to be regarded as less compliant than other customers. Few differences were found between the results for the Finnish and the Swedish groups, indicating that the professional culture in the two countries is similar. The study found that the pharmacist's judgment of the level of drug compliance is influenced by the pharmacist's metacognitive assumptions regarding the customer's personality and the situation within which the customer acts.
Patient satisfaction with arthritis medication
Authors: Long A , Wynne H A
Published: February 2011

Patient derived information to support the long term use of non-steroidal anti-inflammatory drugs (NSAIDs) is lacking. In contrast, data detailing the adverse effects of individual NSAIDs is accumulating. We determined the importance of NSAIDs as therapy to 153 patients with osteoarthritis (age range 36 to 92), comparing results in elderly and younger patients. Around half of the patients reported moderate relief of symptoms, with a further quarter reporting good, or even excellent, relief. One half of patients aged 75 years or less, but only one fifth of patients aged over 75 years, recalled having been informed of the adverse effects of NSAIDs. A total of 59 per cent of patients reported having used simple analgesics, such as paracetamol, as first line therapy. As some patients are helped by them, we suggest that efforts should be directed towards increasing the first line use of simple analgesics in patients with osteoarthritis and towards increasing patient awareness of potential NSAID-related adverse effects.
Evaluation of the impact of recent changes in postgraduate continuing education for community pharmacists in England
Authors: Mottram David R , Rowe Philip H
Published: February 2011

Postgraduate continuing education for community pharmacists in England has undergone a radical change since the establishment of the Centre for Pharmacy Postgraduate Education (CPPE) in 1992. The present study was undertaken to assess the impact of the introduction of the CPPE on levels of participation and attitudes towards continuing education. Comparisons are drawn with an analysis made in 1991. Results showed that 76.8 per cent of respondents had participated in CPPE-based continuing education, as either workshops or distance learning. This level of participation is far higher than that previously recorded. Those pharmacists who attended the workshops also tended to request distance learning packages, while a significant proportion of users of distance learning declined to attend workshops. Owners of community pharmacies were significantly more likely than managers to use computer assisted learning material. Attitudes concerning restraints against participation in continuing education focused on the value pharmacists place on their spare time and the absence of a postgraduate education allowance for community pharmacists.
Role of the community pharmacist in the care of patients with chronic schizophrenia in the community
Authors: Maslen C L , Rees L , Redfern P H
Published: February 2011

This study, using a postal questionnaire, investigated the involvement of 534 community pharmacists with patients suffering from schizophrenia. The majority of the 236 respondents regularly dispensed medication for patients with schizophrenia and almost three-quarters had been asked for advice about medication from such patients or their carers. However, the majority of respondents believed that the advice they could give to these patients was limited by their knowledge of schizophrenia (86 per cent) and of therapeutics (70 per cent). Other perceived constraints to giving advice included lack of contact with other health professionals, poor communication skills and lack of experience in dealing with the mentally ill. Respondents were significantly less confident about advising patients with schizophrenia than advising other patient groups. The results suggest that there is a need to encourage community pharmacists' participation in continuing education and to improve liaison with other community health professionals such as community psychiatric nurses.
The management and development of hospital pharmacy in the new National Health Service in the UK
Authors: Cotter Siobhan M , McKee Martin , Strong Philip M
Published: February 2011

The introduction of an internal market in health care in the United Kingdom has created a structured relationship, defined by contracts, between health care providers, such as NHS hospitals, and purchasers, such as general practitioner fundholders. Similar relationships are developing within hospitals between clinical directorates and support service departments, such as pharmacy. A 1993/4 interview survey, conducted at eight hospitals, obtained the views of 129 pharmacy, nursing, medical and managerial staff on pharmacy service development and management in this new environment. Contracts between pharmacy and clinical directorates were in place in only two of the hospitals. Where contracts existed, pharmacy managers viewed them positively but they acknowledged the resultant managerial challenges. Most pharmacy managers at sites without contracts were threatened by the prospect of them. In contrast, non-pharmacy staff welcomed contracts as an opportunity to define their service requirements. For most managers of support services such as pharmacy, the implementation of the internal market will present challenges. Managers will need to become familiar with their customers' needs using information from several sources, including pharmacists working within directorates. Then efforts will have to be made to negotiate contracts that meet those needs while permitting the further development of staff and services.