bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional variations in HIV disclosure in Thailand: implications for future interventions
Authors: Lee S-J , Li L , Jiraphongsa C , Iamsirithaworn S , Khumtong S , Rotheram-Borus M J
Published: January 2010

People living with HIV (PLH) in Thailand face tremendous challenges, including HIV disclosure. With the advent of antiretroviral (ARV) therapy in Thailand, the positive benefits of HIV disclosure are becoming more salient. However, there are regional variations in the levels of HIV disclosure in Thailand. We examined and compared the levels of HIV disclosure in Northern and Northeastern Thailand. PLH ( N = 410) were recruited from four district hospitals in the North and the Northeast. More PLH in the North reported disclosing HIV status to at least one family member in the household. PLH in the Northeast reported significantly lower levels of HIV disclosure within family and outside of family. HIV disclosure remains a significant challenge in Thailand, especially in the Northeast. We propose future interventions focusing on HIV disclosure to address the specific concerns and barriers to HIV disclosure, taking into account the regional differences in HIV disclosure.
Syphilitic aneurysm
Authors: Gowland P-A , Musleh G , Koukis I , McLaughlin K E
Published: January 2010

Syphilis was once the most common cause of aortic aneurysm. For the last 60 years syphilis has been well controlled in the UK population. However, we present the recent case of a 52-year-old female black South African immigrant who was found to have a syphilitic aneurysm.
Community Professionals’ Management of Client Care: A Mixed-Methods Systematic Review
Authors: Kolehmainen Niina , Francis Jill , Duncan Edward , Fraser Cynthia
Published: January 2010

Objectives

To review the literature on individual community professionals’ caseload management (behaviours related to assessment, treatment and discharging of clients) to identify the main themes and concepts, and to synthesize the findings to inform practice, policy and research.

Methods

Publications were systematically identified from electronic databases, hand searches of bibliographies, and contact with professional organizations. There were no restrictions on language, the nature of publications or publication year. Procedures were systematically applied for quality appraisal and data extraction. Qualitative and descriptive quantitative methods were used for data analysis and synthesis.

Results

Search criteria yielded 2048 papers of which 42 papers met the inclusion criteria. Thirty-five percent of these were based on research, the rest on professionals’ experiences. The papers covered 16 professional and 20 client populations, and their quality was generally poor. Analysis identified six broad themes: definitions of caseload management, caseload measurement and ‘tools’, models of caseload management practice, client- professional relationship, discharging and professional guidance. Six papers presented issues that related to but did not fit within these themes. Current caseload management tools and models of caseload management practice had a poor evidence base. Five papers described benefits of team-based approaches. Professional guidance for caseload management is limited in detail and relevance to daily practice.

Conclusions

Although there is a considerable literature on caseload management, it is not possible to make summative conclusions. Policy-makers and professional bodies should encourage and support development of research evidence about the ways to achieve effective, efficient and equitable caseload management. Health and social care services considering implementing caseload management tools or models of practice should critically appraise their basis, and consider their potential advantages as well as disadvantages.
Scoping Review and Approach to Appraisal of Interventions Intended to Involve Patients in Patient Safety
Authors: Peat Maggie , Entwistle Vikki , Hall Jill , Birks Yvonne , Golder Su
Published: January 2010

Objective

To review the literature on the involvement of patients in efforts to promote their own or others’ safety while using health care services.

Method

A total of 1933 reports were identified as potentially relevant and 745 of these were included in the review (437 descriptions of interventions, 299 comment or opinion pieces and 42 discussions or studies of patients’ willingness and ability to adopt safety-promoting behaviours).

Results

The rate of publication on these topics has increased, especially in the USA and UK. However, there is scant evidence of the impact of patient involvement initiatives on safety outcomes and there has been little exploration of patients’ willingness and ability to adopt particular safety-oriented behaviours. We identified three broad routes by which patients’ actions might contribute to their safety by helping to make sure that: their treatment is appropriate for them (informing the management plan); treatment is given as planned and according to appropriate protocols (monitoring and ensuring safe delivery of treatment); and problems and risks within health care systems are identified and reduced (informing systems improvements).

Conclusions

An approach for appraising interventions intended to promote patient involvement in patient safety should involve: identification of the routes by which interventions assume patients’ actions might contribute to their safety; identification of the conditions that would need to be met for patients to behave and contribute as the interventions (implicitly) assume; examination of the extent to which the intervention supports fulfilment of those conditions; and consideration of the potential negative effects of the intervention.
Why is Patient Safety so Hard? A Selective Review of Ethnographic Studies
Authors: Dixon-Woods Mary
Published: January 2010

Ethnographic studies are valuable in studying patient safety. This is a narrative review of four reports of ethnographic studies of patient safety in UK hospitals conducted as part of the Patient Safety Research Programme. Three of these studies were undertaken in operating theatres and one in an A&E Department. The studies found that hospitals were rarely geared towards ensuring perfect performances. The coordination and mobilization of the large number of inter-dependent processes and resources needed to support the achievement of tasks was rarely optimal. This produced significant strain that staff learned to tolerate by developing various compensatory strategies. Teamwork and inter-professional communication did not always function sufficiently well to ensure that basic procedural information was shared or that the required sequence of events was planned. Staff did not always do the right things, for a wide range of different reasons, including contestations about what counted as the right thing. Structures of authority and accountability were not always clear or well-functioning. Patient safety incidents were usually not reported, though there were many different reasons for this. It can be concluded that securing patient safety is hard. There are multiple interacting influences on safety, and solutions need to be based on a sound understanding of the nature of the problems and which approaches are likely to be best suited to resolving them. Some solutions that appear attractive and straightforward are likely to founder. Addressing safety problems requires acknowledgement that patient safety is not simply a technical issue, but a site of organizational and professional politics.
Learning About Patient Safety: Organizational Context and Culture in the Education of Health Care Professionals
Authors: Pearson Pauline , Steven Alison , Howe Amanda , Sheikh Aziz , Ashcroft Darren , Smith Pam
Published: January 2010

Objectives

This study investigated the formal and informal ways pre-registration students from medicine, nursing, physiotherapy and pharmacy learn about keeping patients safe. This paper gives an overview of the study and explores findings in relation to organizational context and culture.

Methods

The study employed a phased design using multiple qualitative methods. The overall approach drew on ‘illuminative evaluation’. Ethical approval was obtained. Phase 1 employed a convenience sample of 13 pre-registration courses across the UK. Curriculum documents were gathered, and course directors interviewed. Phase 2 used eight case studies, two for each professional group, to develop an in-depth investigation of learning across university and practice by students and newly-qualified practitioners in relation to patient safety, and to examine the organizational culture that students and newly-qualified staff are exposed to. Analysis was iterative and ongoing throughout the study, using frameworks agreed by all researchers.

Results

Patient safety was felt to have become a higher priority for the health care system in recent years. Incident reporting was a key feature of the patient safety agenda within the organizations examined. Staff were often unclear or too busy to report. On the whole, students were not engaged and may not be aware of incident reporting schemes. They may not have access to existing systems in their organization. Most did not access employers’ induction programmes. Some training sessions occasionally included students but this did not appear to be routine.

Conclusions

Action is needed to develop an efficient interface between employers and education providers to develop up-to-date curricula for patient safety.
Patient Safety - What Claims Against the Nhs Can Teach us
Authors: Esmail Aneez
Published: January 2010

The study, first published in 2004, looks at databases on clinical negligence litigation, what kind of claims for clinical negligence there have been, and studies cases in different settings such as general practice, general surgery and medicine, psychiatry and obstetrics.
How Effective is Training to Help Staff Deal with Obstetric Emergencies
Authors: Strachan Bryony
Published: January 2010

The study, first published in 2008, examined the efficacy of drill training for staff in dealing with obstetric emergencies; specifically whether it improved their skills and performance.
How to Improve Patient Safety in Surgery
Authors: Vincent Charles
Published: January 2010

The study, first published in 2006, looks at patient safety from the perspective of surgery, looking at surgeons’ technical skills, surgical team performance in the operating theatre, the team's views of their performance, interruptions and distractions, and multidisciplinary team training in surgery using simulated training scenarios.
Safety Alerts on Drugs - How Trusts Follow the Rules
Authors: Sheldon Trevor
Published: January 2010

The study, first published in 2003, looks at how trusts reacted to and implemented a safety alert on a drug, in this case potassium chloride, which can help save lives, but which is dangerous in high concentrations.
Medication Errors - What is the Best Way to Reduce Their Impact on Patients’ Health?
Authors: Karnon Jonathan
Published: January 2010

The study, first released in 2005, looks at medication errors and how they can be reduced. The authors carried out a prospective hazard and improvement analysis, which involved a review of existing research, analysis of existing evidence by experts and calculation of the benefits and costs of three interventions that might reduce the number of medication incidents.
Electronic Prescribing - Safer, Faster, Better?
Authors: Barber Nick
Published: January 2010

The study, first published in 2006, looks at how we should evaluate electronic prescribing systems in hospitals, particularly to improve patient safety. It provides an evaluation framework, compares methodologies to detect prescribing errors and describes the advantages of approaching evaluation of these systems from a sociotechnical perspective. Two electronic prescribing systems are studied using simultaneous quantitative and qualitative approaches. Electronic prescribing systems can reduce the incidence of prescribing error, however their implementation is not straight forward and they should be considered a constant ‘work in progress’.
Ways to Reduce Drug Dose Calculation Errors in Children
Authors: Wong Ian
Published: January 2010

The study, first published in 2007, tried to identify interventions introduced to reduce dose calculation errors in newborn infant and child patients and then to assess their impact on patient care. To do this, the researchers studied existing research, surveyed health care professionals, observed selected interventions and then attempted to do an economic analysis of the most promising interventions.
Diagnosis of Difficult Cases in Primary Care
Authors: Kostopoulou Olga
Published: January 2010

The study, first published in 2008, involved GPs of different levels of experience taking part in a study that used hypothetical clinical scenarios in order to look at what it is that leads GPs to make diagnosis errors and whether there are common characteristics of diseases that GPs might often miss.
Testing New Devices to Help Prevent ‘Misconnection’ Errors in Health Care
Authors: Lawton Rebecca
Published: January 2010

The study, the first part of which was published in 2008, looked at, prospectively, how effective and safe new, non-traditional connectors were for use in spinal connector equipment such as spinal needles and infusion lines. The researchers analysed existing evidence on adverse incidents in this area, held workshops to discuss the problem, tested new devices with a simulator, and evaluated them in clinical practice trials at four different hospitals in England.
The use of propofol and sevoflurane for surgical anaesthesia in New Zealand White rabbits
Authors: Allweiler Sandra , Leach Matt C , Flecknell Paul A
Published: January 2010

New Zealand White (NZW) rabbits ( n = 34) received intravenous propofol (16 ± 5 mg/kg) for induction of anaesthesia followed by maintenance with sevoflurane (4.0 ± 0.5%) in oxygen. All animals underwent ovariohysterectomy. Heart rate, respiratory rate, haemoglobin oxygen saturation, end-tidal carbon dioxide concentration, end-tidal sevoflurane concentration and oesophageal temperature were monitored every 5 min. Time from induction of anaesthesia to tracheal extubation and sternal recumbency were recorded as was the quality of recovery. Direct arterial blood pressure values (mmHg) were recorded every 5 min from 19 rabbits and 22 arterial blood gases analyses were performed (11 postintubation and 11 at the time of recovery). Propofol produced smooth induction of anaesthesia without production of apnoea. Intubation was successfully performed in all but one rabbit in an average of 4 ± 3 min from the beginning of propofol administration. No ventilatory support was required during the anaesthetic period. Respiratory rate averaged 51 ± 8 bpm and end-tidal CO2 (kPa) was 4.0 ± 0.5 mmHg during anaesthesia. Blood gas values were maintained within normal limits and average mean arterial blood pressure was 73.4 ± 7.9 mmHg. Time to regain the swallowing reflex following discontinuation of sevoflurane was 2 ± 1 min and time to sternal recumbency was 8 ± 0.3 min. No anaesthetic-related mortality occurred and all animals recovered uneventfully. Propofol–sevoflurane anaesthesia produced a good quality of surgical anaesthesia for ovariohysterectomy and stable cardiopulmonary conditions. Propofol–sevoflurane anaesthesia in young healthy NZW rabbits appears to be an effective and practically useful method of anaesthesia.
Faecal glucocorticoid metabolites: How to express yourself – comparison of absolute amounts versus concentrations in samples from a study in laboratory rats
Authors: Lepschy M , Touma C , Palme R
Published: January 2010

During the last two decades, measurement of faecal Cortisol or corticosterone metabolites (FCM) has become one of the most important tools to non-invasively monitor stress in animals. However, to reliably assess an animal's adrenocortical activity, a careful validation of this technique for each species and sex investigated is obligatory. Usually results in these validation studies and in subsequent applications are expressed as concentration (FCMconc). Nevertheless, some authors express their results as absolute amounts (FCMabs) and claim this to be more accurate. A physiological validation to prove this assumption, however, is still missing as well as information about the influence of the intervals set for faecal sampling, although the chosen intervals might play an important role. Since FCMconc and FCMabs may differ and therefore lead to different conclusions, our study aimed to gain fundamental and scientifically valid information about these parameters by re-analysing a set of data obtained in a study on laboratory rats. The data basis used was derived from four validation experiments performed in male and female rats: an adrenocorticotrophic hormone challenge test, a dexamethasone (Dex) suppression test, an investigation of the diurnal variation (DV) of glucocorticoids and the stress response in reaction to the injection procedure itself (for details see Lepschy et al. Non-invasive measurement of adrenocortical activity in male and female rats. Lab Anim 2007;41:372–87). Faecal samples were collected in short time intervals and the exact amount of faeces voided during each sampling interval was documented. Throughout all performed tests strong positive correlations between FCMconc and FCMabs were found (median of rs > 0.72). In males, for all calculated sampling intervals (4, 8 and 12 h) pharmacological stimulation, suppression and the DV of adrenocortical activity were reflected accurately using both FCMconc and FCMabs. In females, suppression of FCM by Dex was also clearly reflected in both systems. However, pharmacological stimulation was only reflected accurately by means of FCMconc, which clearly limits the usability of FCMabs. Thus, using the data of physiological validation experiments, we clearly demonstrate for the first time advantages and disadvantages of presenting results as FCMconc or FCMabs. Based on our findings in laboratory animals such as rats, giving results as FCMconc seems to be more appropriate and FCMabs - if at all - might only be used as an addition.
An Analytical Model of FRP-Concrete Bond Deterioration in Moist Environment
Authors: Ouyang Zhenyu , Wan Baolin
Published: January 2010

Debonding of FRP from concrete substrate can lead to premature failure of the FRP repaired or retrofitted concrete structures. Therefore, FRP-concrete bond is a major factor affecting the performance of FRP strengthened concrete members. Experimental studies show that moisture plays an important role in the reliability of the bond between FRP and concrete. In this study, a cohesive zone model (CZM) of debonding along the FRP–concrete interface under peel load was analytically established by using a linear elastic separation-stress law. The interface region relative humidity (IRRH) was selected as the primary factor to study the bond durability of FRP/concrete bond. Based on a nonlinear deterioration model, the analytical solution of the CZM was used to determine critical load vs. crack length relations ( P-a curves) of Modified Double Cantilever Beam (MDCB) specimens at different moisture exposure durations. The good agreement with experimental data indicates that the CZM for FRP-concrete joint is an efficient way to analyze bond behavior in moist environments.
Intermediate Crack Induced Debonding in Concrete Beams Strengthened with CFRP Plates — An Experimental Study
Authors: Rusinowski Piotr , Täljsten Björn
Published: January 2010

FRP composites are becoming a material of choice in an increasing number of rehabilitation and retrofitting projects around the world. Depending on the design objectives, these materials can be used to improve one or more of the structural member characteristics, such as the load capacity, ductility and even durability. Design of structural strengthening applications using externally bonded FRP composites is usually based on conventional design approaches with improvement to account for the presence and characteristics of the FRP material. Non-conventional design issues that are specific to the type of application require special considerations for their proper inclusion in the design process. One such design issue is the debonding problems in externally bonded FRP strengthening applications that have been a concern and a research challenge since the initial development stages of the strengthening method. End-peeling has governed a large interest and several debonding models have been presented. However, interfacial peeling at flexural cracks has not attained the same focus – even though this debonding failure is most likely more common. This paper presents laboratory tests of concrete beams strengthened in flexure with CFRP epoxy bonded plates. Wrapping with CFRP sheets was applied in order to try to localize the failure initiation. Concrete cracking as well as debonding initiation and propagation was possible to observe with help of advanced optical measuring system and high speed camera.
Theoretical Solution for Fatigue Debonding Growth and Fatigue Life Prediction of FRP-Concrete Interfaces
Authors: Diab H.M. , Wu Z. , Iwashita K.
Published: January 2010

This paper presents an analytical solution for the evolution and distribution of shear stresses along the entire bond length of FRP-concrete interfaces due to mode-II fatigue loading. The creep-fatigue interaction and fatigue crack growth after debonding initiation are incorporated into a nonlinear interfacial constitutive law. While the creep-fatigue interaction is represented by the degradation of the interfacial stiffness, the debond growth is governed by a form of the Paris equation and the fracture energy ratio, Gmax/Gc. Furthermore, a new form of energy ratio is adopted to be debond-dependent. Through a series of experimental double-lap shear specimens, the results showed that the debond growth rate ( da/dN) along the FRP-concrete interfaces diminishes with fatigue cycles and that 30% of the static bond capacity of the FRP-concrete interface can be considered as the endurance limit of fatigue loading for FRP-strengthened beams. The agreement between the theoretical predictions and experimental results is valid, with a good degree of accuracy.
Influence of Bond on the Hinge Rotation of FRP Plated Beams
Authors: Haskett M. , Ali M.S. Mohamed , Oehlers D.J. , Wu C.
Published: January 2010

Fibre reinforced polymer (FRP) plate reinforcement is a brittle material which has a brittle interfacial bond with concrete. This can lead to the misconception that all FRP retrofitting techniques provide brittle members and, hence, limited rotational capacity which has severe limitations for structural applications. This paper shows that the FRP reinforcement behaviour is but one of three components that govern the rotational capacity of plated reinforced concrete beam hinges. It is shown that FRP retrofitted beams and slabs can achieve ductile behaviour and provide rotational capacity and, furthermore, that the rotational capacity of FRP plated members depends very importantly on the interface bond characteristics.
Bonded Fibre Reinforced Polymer Strengthening in a Real Fire
Authors: Stratford T.J. , Gillie M. , Chen J.F. , Usmani A.S.
Published: January 2010

FRP strengthening is critically dependent upon the bonding adhesive. The adhesive used is typically an ambient cure epoxy with a glass transition temperature as low as 60°C. This paper describes the performance of bonded FRP strengthening within real compartment fires (the Dalmarnock Fire Tests), one of which was allowed to grow past flashover. The aim of these real fire tests was to complement the laboratory-based fire tests on FRP strengthened members that are currently being undertaken at various research centres. In this study, externally bonded plate and near-surface-mounted FRP strengthening were applied to the ceiling of a concrete structure. The FRP was protected using either an intumescent coating or gypsum boards, alongside FRP that was left unprotected. The tests demonstrated the vulnerability of FRP strengthening during a real compartment fire. The glass transition temperature was rapidly exceeded in the bonding adhesive for all samples. The near-surface mounted strengthening and the gypsum board protected strengthening was in a visibly better condition after the fire.
FRP-Concrete Bond Behaviour under Cyclic Debonding Force
Authors: Mazzotti C. , Savoia M.
Published: January 2010

The strengthening of concrete structures against earthquake actions is one of the most important application of FRP; nevertheless, the effect of cyclic forces on FRP – concrete bonding has been scarcely experimentally investigated. This paper presents the results of an experimental campaign on FRP-concrete specimens subject to shear cycles at very high force levels, typical of earthquake excitation. Both CFRP plate and CFRP sheet have been tested. An experimental set-up (single shear test) allowing for stable debonding process has been adopted and both strain gauges along the FRP plate and LVDT transducers have been used. The sequences of the cyclic loadings under traction have been prescribed by controlling the progression of the debonding. It is shown that the debonding force is not affected by cyclic loadings; a small degradation of the interface behaviour, with the reduction of the maximum shear stress, has been detected only after the onset of debonding. Nevertheless, this reduction, analogous to that showed by monotonic loading tests, remains constant during the development of the debonding and is not modified by further application of cyclic loads at very high force level.
Analyzing mRNA expression identifies Smad3 as a microRNA-140 target regulated only at protein level
Authors: Pais Helio , Nicolas Francisco Esteban , Soond Surinder M. , Swingler Tracey E. , Clark Ian M. , Chantry Andrew , Moulton Vincent , Dalmay Tamas
Published: January 2010

mRNA profiling is routinely used to identify microRNA targets, however, this high-throughput technology is not suitable for identifying targets regulated only at protein level. Here, we have developed and validated a novel methodology based on computational analysis of promoter sequences combined with mRNA microarray experiments to reveal transcription factors that are direct microRNA targets at the protein level. Using this approach we identified Smad3, a key transcription factor in the TGFβ signaling pathway, as a direct miR-140 target. We showed that miR-140 suppressed the TGFβ pathway through repression of Smad3 and that TGFβ suppressed the accumulation of miR-140 forming a double negative feedback loop. Our findings establish a valid strategy for the discovery of microRNA targets regulated only at protein level, and we propose that additional targets could be identified by re-analysis of existing microarray datasets.
Quinine-Quinidine Mix-Ups Still Happen; APSF Offers Recommendations for Safe Postop Opioid Administration and Monitoring
Authors: Cohen Michael R. , Smetzer Judy L.
Published: January 2010

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site ( www.ismp.org ), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.
Interferon Beta—Induced Panniculitis Mimicking Acute Appendicitis; Acute Methotrexate Neurotoxicity with Associated Choreiform Movements; Chorea Associated with Gabapentin Use; Acute Interstitial Nephritis Associated with Linezolid; Atypical Neuroleptic Malignant Syndrome with Quetiapine; Hypersensitivity Reactions to Generic Drugs with Soybean Oil
Authors: Shuster Joel
Published: January 2010

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MEDWATCH program (800-FDA-1088). If you have reported an interesting, preventable ADR to MEDWATCH, please consider sharing the account with our readers.
Development and Implementation of a Pharmacy Fall Prevention Program
Authors: Beasley Burl , Patatanian Edna
Published: January 2010

Purpose

Describe the development, implementation, and outcomes of a pharmacy fall prevention program (PFPP) that incorporates medication profile review and a medication fall risk score to identify high-risk patients.

Falls are a common cause of morbidity and mortality among elderly patients in the United States. Injury-related falls may contribute to frequent visits to emergency departments (EDs) and hospitals, as well as functional and emotional decline. Falls account for more than 10% of ED visits and more than 5% of hospital visits. Numerous reports describe common risk factors associated with falls of hospitalized patients and which safety measures should be taken to prevent or eliminate falls. The fall prevention program has a positive financial impact by reducing injury falls in hospitalized patients. During the first 2 years of implementation, the injury fall rate decreased from 2.06 to 1.07 per 1,000 patient-days (48%). The total falls rate decreased from 5.13 to 3.59 per 1,000 patient-days (30%). This program showed a savings of $217,000 per year in prevented falls.

Conclusion

Incorporating medications and their related adverse effects into a fall prevention program is an integral part of a multidisciplinary approach to reduce total falls and related injuries. The decrease in falls has improved patient safety and quality of care.
A Retrospective Review of Short-Term Outcomes after Switching Patients from Clopidogrel to Alternative Antiplatelet Therapy
Authors: Fjeldheim Renae , Welch Justin , Koo Ji
Published: January 2010

Purpose

To describe a process used at one facility to switch patients receiving clopidogrel to another antiplatelet therapy when appropriate. Additionally, to evaluate adverse effects in these patients and estimate drug acquisition cost savings.

Methods

Clinical pharmacists reviewed patient charts and recommended switching antiplatelet therapy where appropriate, based on established facility criteria. Charts were later reviewed in an outcomes assessment for those patients who were switched. Primary outcomes assessed included ischemic and bleeding events; secondary outcomes included net change in use of proton pump inhibitors or histamine H2 antagonists, headache, gastrointestinal (GI) upset, allergy, and clopidogrel reinitiation. Drug acquisition cost savings was also estimated.

Results

A total of 560 patient charts were reviewed, and 373 clopidogrel prescriptions were discontinued. Outcomes were assessed for 215 patients. In total, 20.9% of patients were taking clopidogrel for indications outside the established criteria. Patients were switched to aspirin (48.8%), Aggrenox plus aspirin (29.3%), Aggrenox only (14%), no antiplatelet (7.4%), or warfarin (0.5%). The total ischemic event rate was 5.6%, with all cerebrovascular ischemic events occurring in patients taking Aggrenox plus aspirin. The mean bleeding rate was 5.6%, with 1 major bleeding event. Headache, GI upset, and allergy were reported only in patients taking Aggrenox (with or without additional aspirin). Primarily because of adverse effects of Aggrenox, 23 patients were restarted on clopidogrel. Estimated drug acquisition cost savings at 12 months was approximately $136,500.

Conclusions

A large number of patients were taking clopidogrel for indications and/or durations outside established guidelines, and most were satisfactory candidates for other antiplatelet medications. Adverse ischemic and bleeding events were comparable with rates previously reported in literature. Patients who were switched to Aggrenox plus aspirin had the highest rates of ischemic events and adverse drug reactions, and were most likely to restart clopidogrel. Nearly 90% of patients tolerated the new antiplatelet therapy at the time of the outcomes review. As a result, the facility was able to appreciate a drug acquisition cost savings.
Dronedarone
Authors: Cada Dennis J. , Levien Terri L. , Baker Danial E.
Published: January 2010

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing inservices. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent in print and are also available online. Monographs can be customized to meet the needs of a facility. Subscribers to The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The December 2009 monograph topics are on ustekinumab, pralatrexate injection, vigabatrin, bepotastine besilate ophthalmic solution 1.5%, and ganciclovir ophthalmic gel 0.15%. The DUE is on ustekinumab.
New Drugs Approved by the FDA; New Dosage Forms and Indications Approved by the FDA; Agents Pending FDA Approval; New Drug/Biologics License Applications Filed by Manufacturer; Significant Labeling Changes or “Dear Health Care Professional” Letters Related to Safety
Authors: Baker Danial E.
Published: January 2010

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

Whenever we speak to pharmacists in seminars around the country, we ask the question, “How much of the available capability in your computer and smart phone are you utilizing?” The typical answer is between 5% and 10%. In the past, we held technology “boot camps” to rectify this situation. People traveled to Auburn from as far away as the UK to attend 2-day sessions focused on skill building, beginning with how to find the power switch. Since that time, we have presented our boot camps at health systems. Most health systems were focused on developing foundational skills in physicians who were reluctant to use electronic clinical applications.
Glycemic Control during Critical Illness: Tight or Not?
Authors: Dickerson Roland N.
Published: January 2010

Nutrition Support Pharmacist features issues pertinent to the practice of clinical pharmacy in the area of metabolic support. In this review, a critical analysis of six current major intensive insulin therapy trials (Leuven I, Leuven II, Leuven III, NICE-SUGAR, VISEP, and Glucontrol) for critically ill surgical and medical patients is provided. Practical suggestions for managing hyperglycemia, defining an effective target blood glucose concentration range, avoiding hypoglycemia, and designing a safe and effective insulin infusion algorithm are given.
New Drug Approvals: Silodosin for Benign Prostatic Hyperplasia
Authors: Cantrell Matthew A , Bream-Rouwenhorst Heather R , Hemerson Phyllis , Magera James S
Published: January 2010

Objective:

To review the pharmacology, pharmacokinetics, clinical trials, and safety of silodosin, a recently approved α1A-adrenergic receptor (AR) antagonist for benign prostatic hyperplasia (BPH).

Data Sources:

English-only articles obtained from MEDLINE (1966–October 2009) using the search terms silodosin and KMD-3213 were reviewed. In addition, a search of International Pharmaceutical Abstracts (1970–October 2009) was conducted.

Study Selection and Data Extraction:

Available English-language articles were reviewed, as well as abstracts from available non-English articles.

Data Synthesis:

Silodosin reduces urinary symptoms associated with BPH in as little as 1 day after initiation. The largest clinical trial conducted to date demonstrated a decrease in International Prostate Symptom Score of –6.4 ± 6.63 points compared to –3.5 ± 5.84 in patients receiving placebo (p < 0.0001). Silodosin also improved urinary flow rates by approximately 2.8 ± 3.44 mL/sec, which is comparable to other α1-AR antagonists. The usual dose of silodosin is 8 mg once daily and should be reduced to 4 mg for patients with moderate renal dysfunction. Use is contra indicated in patients with severe renal and hepatic impairment or taking strong CYP3A4 inhibitors. In clinical trials, the most prevalent adverse effects were ejaculatory disturbances, occurring in approximately 28% of patients, although only 2.8% of patients discontinued treatment due to this adverse effect. Preliminary data suggest that, similar to other third-generation α1A-AR antagonists, silodosin has little potential to cause significant cardiovascular adverse effects such as orthostatic hypotension or syncope. To confirm these findings, long-term studies are still needed, especially in patients taking antihypertensive agents and in those with a history of intolerance to other α1-AR antagonists.

Conclusions:

Silodosin was approved by the Food and Drug Administration in 2008. Long-term studies demonstrating improvement in clinically Important outcomes of BPH have yet to be published. In addition, pharmacoeconomic analyses would assist in defining its current place in therapy. Until this information is available, silodosin may be best reserved as an alternative to other second- and third-generation α1-AR antagonists.
Medication Changes Prior to Hospitalization for Obstructive Lung Disease: A Case-Crossover Study
Authors: Velthove Karin J , Leufkens Hubert GM , Schweizer René C , Solinge Wouter W van , Souverein Patrick C
Published: January 2010

Background:

Hospitalizations have always been seen as a solid outcome parameter in pharmacoepidemiology. However, the period leading to hospitalization and prehospital management of the patient are equally important.

Objective:

To evaluate medication changes in the period prior to hospitalization for obstructive lung disease and to quantify the association between medication use and the risk of hospitalization.

Methods:

We conducted a case-crossover study using the PHARMO record linkage system, which contains drug dispensing data from community pharmacies and hospital admission data. Patients included in the study were adults hospitalized for obstructive lung disease between 2005 and 2007. The index date of the case period was the date of hospitalization, and control moments were set at 3, 6, 9, and 12 months before admission. For each patient, all prescriptions prior to the date of hospitalization were identified. Medication use was ascertained in a 90-day time window prior to each case or control moment.

Results:

We identified 1481 patients who were hospitalized for obstructive lung disease. It appeared that respiratory medication use increased in the 90 days prior to hospitalization. Hospitalization was associated with the use of 3 or more respiratory drugs (OR 2.2; 95% CI 1.8 to 2.8), systemic glucocorticoids (OR 4.5; 95% CI 3.8 to 5.4), and antibiotics (OR 3.1; 95% CI 2.7 to 3.6).

Conclusions:

The use of systemic glucocorticoids, antibiotics, and other respiratory drugs increased prior to hospitalization for obstructive lung disease. These results could be indicative of the development and/or treatment of an exacerbation. There is a need for markers to detect exacerbations in an early phase in order to start treatment as early as possible and possibly prevent hospitalizations for obstructive lung disease.
Variation of Preferred Orientation in Oriented Clay Mounts as a Result of Sample Preparation and Composition
Authors: Dohrmann R. , Rüping K. B. , Kleber M. , Ufer K. , Jahn R.
Published: January 2010

In X-ray diffraction (XRD) analysis, preparation of oriented clay specimens enhances their 00l reflections by arranging basal surfaces parallel to the specimen surface. In one-dimensional modeling of XRD intensities, degree of preferred orientation is one of the variable parameters and a user may choose different σ* values for different minerals. The usual assumption is, however, that the layers of all clay minerals that are present exhibit a similar degree of preferred orientation to that of the clay mineral flakes parallel to the basal plane. If the orientation of individual clay minerals is significantly different, and if this is not taken into account, the relative proportions of the constituent minerals cannot be modeled accurately. The actual or so-called ‘preferred’ orientation is a potentially large source of error in any attempt at quantitative XRD analysis because it cannot be assumed to be constant among different minerals and may also vary as a result of pretreatment. In the present study the influence of sample composition and sample pretreatment on the degree of preferred orientation was determined using the parameter σ*. A statistical parameter was calculated to determine and ensure the reproducibility of σ* measurements. The most important result was that, when mixed together, clay minerals influence each other in terms of the degree of preferred orientation. Among individual samples, the degree of preferred orientation can be different for each clay mineral. The power of sonication used in sample pretreatment of a pure kaolinite and a pure illite had no significant influence on the degree of preferred orientation. The changes in intensities upon variation of the tilting angle (χ) allowed for calculation of σ* of smectites in pure samples, in admixtures, and in samples treated in two different ways (air-dried and glycerol-intercalated), which is reported here for the first time. Smectites are very fine grained with flexible morphology which is believed to be the reason for their tendency to exhibit poor orientation (σ* = 22°); further research is required to establish whether this is a general feature of smectites. After glycerol treatment a soil smectite showed a slightly better orientation compared to the air-dried pattern. The results of the study illustrate the difficulty of predicting changes in preferred orientation of clay mineral admixtures, even if non-platy minerals such as clay-sized quartz are added. In general, σ* decreased when non-platy minerals were added, which is explained by changes in geometry of the specimen. Not all clay minerals, however, showed simultaneous changes in their orientation behavior.
AFM Study of Smectites in Hybrid Langmuir-Blodgett Films: Saponite, Wyoming Bentonite, Hectorite, and Laponite
Authors: Szabó Tamás , Wang Jun , Volodin Alexander , van Haesendonck Chris , Dekany Imre , Schoonheydt Robert A.
Published: January 2010

The sizes and shapes of single clay mineral layers are difficult to determine though they are important parameters which determine the final properties of clay polymer nanocomposites and of ultrathin clay mineral films. To determine these sizes and shapes, hybrid monolayers of clay minerals (saponite, hectorite, Wyoming bentonite, and Laponite) and Rhodamine B octadecyl ester Perchlorate (RhB18) were prepared using the Langmuir-Blodgett (LB) technique and studied with atomic force microscopy (AFM). The AFM images reveal monolayers of elementary clay mineral layers, which are randomly oriented and have a wide range of sizes. The layers have typical shapes: lath-like for hectorite, plates for Wyoming bentonite, a mixture of laths and plates for saponite, and aggregates of very small layers of Laponite. Two types of layers were present in the LB films of saponite, Wyoming bentonite, and hectorite in a 40:60 ratio: (1) single layers 0.96 nm thick hybridized with RhB18; and (2) particles consisting of two clay layers with an intercalated monomolecular layer of water molecules and hybridized with RhB18. The Laponite particles in the hybrid LB films consist mainly of aggregates of two and three single layers.
Birnessites with Different Average Manganese Oxidation States Synthesized, Characterized, and Transformed to Todorokite at Atmospheric Pressure
Authors: Cui Haojie , Qiu Guohong , Feng Xionghan , Tan Wenfeng , Liu Fan
Published: January 2010

Todorokite is a common manganese oxide mineral, with a tunnel structure, found in Earth surface environments, and is easily synthesized from layered birnessite. The aim of the current study was to prepare birnessites with different average manganese oxidation states (AOS) by controlling the <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:c="http://cambridge.org/core/content" xmlns:core="http://cambridge.org/core" xmlns:m="http://cambridge.org/core/metadata" xmlns:cup="http://contentservices.cambridge.org" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mnf="http://cambridge.org/core/manifest">MnO4−/Mn2+\$\end{document} ratio in concentrated NaOH or KOH. A series of (Na,K)-birnessites, Na-birnessites, and K-birnessites with different AOS was synthesized successfully in strongly alkaline media. The (Na,K)-birnessites and Na-birnessites prepared in NaOH clearly contained both large (500–1000 nm) and small (40–400 nm), plate-shaped crystallites. The K-birnessites prepared in KOH media consisted mostly of irregular (100–200 nm), plate-shaped crystallites. The degree of transformation of birnessite to todorokite at atmospheric pressure decreased as the AOS values of (Na,K)-birnessites and Na-birnessites increased from 3.51 to 3.80. No todorokite was present when a Na-birnessite with an AOS value of 3.87 was used as the precursor. Pyrophosphate, which is known to form strong complexes with Mn3+ at a pH range of 1–8, was added to a suspension of (Na,K)-birnessites in order to sequester the available Mn3+ in (Na,K)-birnessites. Removal of Mn3+ from birnessite MnO6 layers by pyrophosphate restricted transformation to todorokite — no (Na,K)-birnessite transformed to todorokite after pyrophosphate treatment. The interlayer K+ initially within (Na,K)-birnessites could not be completely ion-exchanged with Mg2+ to form todorokite at atmospheric pressure. No todorokite was forthcoming from K-birnessites even from those with small AOS values (3.50).