bluuebunny/crossref_metadata_2025 huggingface dataset:
Differential impact of landscape transformation on pumas (Puma concolor) and jaguars (Panthera onca) in the Upper Paraná Atlantic Forest
Authors: De Angelo Carlos , Paviolo Agustín , Di Bitetti Mario
Published: February 2011

Aim  Jaguars and pumas, being similar in size and behaviour, are the largest felids of the Neotropics. However, pumas appear to be more resistant to human impacts. Our objective was to compare the response of both species with human impacts at a regional scale in a highly modified region where both species had continuous distribution in the past.

Location  The Upper Parana Atlantic Forest (UPAF).

Methods  Pumas and jaguars presence‐only data were used in an Ecological Niche Factor Analysis (ENFA). From the total number of records, we resampled 95 records of each species 10 times to characterize and compare their habitat requirements, built habitat‐suitability maps and examined interspecific differences in niche parameters related to present landscape characteristics.

Results  Both species showed high dependence on native forest and habitat protection, and low tolerance to anthropogenic environments. However, jaguars showed higher differences between their optimal habitat and the available landscape (mean ± SD; marginality M = 2.290 ± 0.072) and lower tolerance to deviations from their optimal habitat (tolerance T = 0.596 ± 0.013) than pumas (M = 1.358 ± 0.067, P < 0.001; T = 0.742 ± 0.022, P < 0.001). Although their niches highly overlapped (Pianka’s O = 0.746 ± 0.069), pumas’ higher tolerance resulted in a larger area covered by suitable patches of habitat with higher connectivity. All jaguar‐suitable areas were also suitable for pumas; however, 44 ± 8% of puma‐suitable areas were unsuitable or marginal for jaguars.

Main conclusions  Pumas showed more tolerance than jaguars to human impacts at a regional scale in the UPAF, a pattern also observed at local and continental scales. Although the proximate factors responsible for the differential response of pumas to human‐altered environments seem to be similar at all spatial scales (e.g. broader trophic niche than jaguars), the resultant spatial configuration of suitable habitat at a regional scale might be another important factor determining puma persistence and higher jaguar demands on conservation efforts.
Broken Clamp on a Cuffed Tunneled Catheter—Are All Catheters Equal?
Authors: Amin Prashant , Moossavi Shahriar , Vachharajani Tushar J.
Published: February 2011

The use of a cuffed tunneled catheter (CTC) as an initial access in the incident hemodialysis population in the United States remains high. Several different brands of catheters are available for clinical use. Their mechanical problems (such as broken clamps, hubs or leaking and cracked extension tubes) are seldom reported in the literature, even though they add to morbidity and higher health care expense. This study highlights issues related to commonly used catheters and suggests, in the interest of patient safety, a need for improved regulatory oversight in the manufacturing of CTCs.
Political Corruption in Central America: Assessment and Explanation
Authors: Ruhl J. Mark
Published: February 2011

Analysts agree that political corruption is an obstacle to democratic consolidation but disagree about how to measure the extent of corruption in individual nations. This analysis of the Central American countries demonstrates that the most important competing quantitative measures of political corruption produce strikingly different rankings. These contradictory results are caused less by poor measurement techniques than by the existence of two different dimensions of corruption that do not always coincide. Statistical indicators based on expert perceptions of corruption and alternative indicators based on ordinary citizens' firsthand experiences with bribery measure, respectively, grand corruption by senior officials and petty corruption by lower-level functionaries. This study attempts to explain why several Central American nations suffer primarily from one or the other rather than both. It advances recommendations for future research and future anticorruption policies that may be applied to Latin America as a whole.
Political Institutions, Policymaking, and Policy Stability in Latin America
Authors: Pereira Carlos , Singh Shane P. , Mueller Bernardo
Published: February 2011

In some Latin American nations, policy change occurs frequently, while in others it is stable, less prone to shifts with the prevailing political climate or shocks. The conditions under which institutional rules and the powers of key actors influence the capacity for governance vary, and this variation is seldom addressed in the literature. This project examines the effects of the interactions between key policymakers (the executive and the legislature) in Latin America on policy stability across different institutional frameworks. Countries with simultaneously strong executives and weak legislatures are shown to have unstable policy environments, as are countries with a history of unified government and, to a lesser extent, candidate-centered electoral systems.
Distribution of skin temperature in Mexican children
Authors: Kolosovas‐Machuca Eleazar Samuel , González Francisco Javier
Published: February 2011

Background: Infrared thermography can be a valuable diagnostic tool in the evaluation and management of several pathologies; however, the temperature pattern of the healthy body should be known in order to perform a more precise clinical evaluation.

Methods: A total of 25 healthy children (10 female and 15 male) were examined with a thermographic camera. Eighty‐four temperature points of the body were recorded, saved in a database, and analyzed.

Results: The measurements showed that the forehead, neck, and the cervical area have the highest average temperatures of the whole body, and that the temperature distribution between boys and girls is very similar. The difference in skin temperature along the y‐axis of the body varied up to 5.1 °C; however, the average difference in skin temperature along the x‐axis of the body was 0.7 °C. These temperature variations observed in children are lower than the ones reported for adults, which could be due to a greater variation of body fat distribution in adults.

Conclusion: This study shows that thermography could be a good tool for disease diagnosis in children as there is a lower skin temperature variation among children than among adults.
Lack of physical activity in young children is related to higher composite risk factor score for cardiovascular disease
Authors: Tanha Tina , Wollmer Per , Thorsson Ola , Karlsson Magnus K. , Lindén Christian , Andersen Lars B. , Dencker Magnus
Published: February 2011

Aim:  This study evaluates whether accelerometer‐measured physical activity is related to higher composite risk factor scores for cardiovascular disease (CVD) in children.

Methods:  Cross‐sectional study that included 223 children aged 7.9–11.1 years (boys n = 123, girls n = 100). Daily physical activity was assessed by accelerometers for 4 days. Body fat was quantified by dual X‐ray absorptiometry. Maximal oxygen uptake was measured during a maximal exercise test. Resting heart rate and blood pressure were measured. Z‐scores [(value for the individual − mean value for group)/SD] were calculated for each variable, and the sum of different risk factor z‐scores used as an index of composite risk factors score for CVD.

Results:  Partial correlations, from General Linear Model, between moderate to vigorous physical activity (MVPA), vigorous physical activity (VPA) and general physical activity versus index of composite risk factor score were in boys 0.29, 0.33 and 0.30 (all p < 0.05), respectively. The corresponding correlations in girls were −0.28, −0.32 (both p < 0.05) and −0.18 (NS), respectively.

Conclusion:  Low amounts of MVPA and VPA were related to higher composite risk factor scores for CVD in children aged 8–11 years.
Fulminant hepatitis and glomerulonephritis‐a rare presentation of Hepatitis A virus infection
Authors: Pal Radha B , Saha Pritam , Das Ira , Sinha Malay K
Published: February 2011

Aim:  We report a case of fulminant hepatitis and glomerulonephritis by Hepatitis A virus infection.

Methods:  We observed the patient’s clinical course and analyzed his data retrospectively.

Results:  The three‐year‐old boy presented with features of acute renal failure and stage 2 hepatic encephalopathy. Renal biopsy showed diffuse mesangioproliferative glomerulonephritis with immunoglobulin M and complement 3 deposition. After receiving supportive treatment for over 6 weeks, the hepatic and renal function became normal. Renal biopsy after 3 months was normal.

Conclusion:  Acute renal failure is a rare complication of Hepatitis A virus infection. Physicians should be aware of the potential renal involvement of Hepatitis A virus infection as the prognosis is not always favourable.
Brainstem auditory response findings in late preterm infants in neonatal intensive care unit
Authors: Jiang Ze D , Zhou Yi , Ping Li L. , Wilkinson Andrew R
Published: February 2011

Aim:  To examine brainstem auditory function at term in late preterm infants admitted to neonatal intensive care unit (NICU).

Methods:  Fifty‐two preterm infants, born at 33–36 week gestation, were recruited in an NICU and were studied at term using brainstem auditory evoked response (BAER).

Results:  Compared with normal term infants, BAER wave V latency in the NICU preterm infants was increased at 51 and 91/sec (p < 0.05, 0.05). Intervals of III–V and I–V were increased at all 21, 51 and 91/sec clicks (p < 0.05–0.01), which was more significant at higher than lower rates. Interval ratio of III–V/I–III was increased significantly at 51 and 91/sec (p < 0.05 and 0.01). Wave I and III latencies and I–III interval did not differ significantly from normal controls at any click rates. All amplitudes of waves I, III and V amplitude tended to be reduced at higher rates, while wave I amplitude was reduced significantly at 91/sec clicks.

Conclusion:  There were BAER abnormalities in the NICU late preterm infants, suggesting compromised brainstem auditory function. Compared with a basically normal BAER in low‐risk late preterm infants previously reported, the abnormalities suggest that perinatal problems or complications adversely affect the late preterm auditory brainstem.
Packer in Context: Formalism and Fairness in the Due Process Model. Herbert L. Packer. 1968. The Limits of the Criminal Sanction Stanford, CA: Stanford University Press . Pp. viii + 388. $37.95 paper.
Authors: Aviram Hadar
Published: February 2011

Herbert Packer's

The Limits of the Criminal Sanction(1968) has spawned decades of commentary. This essay argues that Packer's two‐model conceptualization of the criminal process is best understood within his professional milieu of doctrinal legal scholarship and the political context of the Warren Court revolution. Within this context, the essay suggests a distinction between two due process visions: formalism and fairness. This distinction is useful for illuminating debates and decisions on criminal procedure matters in the Supreme Court such asTerry v. Ohio(1968) andApprendi v. New Jersey(2000). I conclude by encouraging sensitivity to legal and historical context in future commentary on Packer's framework.
Riding the Trojan horse: combating pest insects with their own symbionts
Authors: Jurkevitch Edouard
Published: February 2011

Insects form an extremely large group of animals and bear a consequently large variety of associated microbes. This microbiota includes very specific and obligate symbionts that provide essential functions to the host, and facultative partners that are not necessarily required for survival. The Tephritidae is a large family that includes many fruit pests such as the Mediterranean fruit fly (the medfly, Ceratitis capitata) and the Olive fly (Bactrocera oleae). Community and functional analyses showed that the microbiota of both flies contribute to their diet, and affect host fitness parameters. The analysis of the microbiota's community structure of mass‐reared, sterilized medfly males used in the sterile insect technique revealed a strong reduction in Klebsiella spp. compared with non‐sterile and wild flies. Inoculation of sterile males with this gut population affected female mating behaviour as they preferentially mated with inoculated versus non‐inoculated males. These studies suggest that control can be significantly improved by manipulating symbionts in pest animals.
The Toughest Nut: Handling Cases Pitting Unrepresented Litigants Against Represented Ones
Authors: Engler Russell
Published: February 2011

Cases pitting unrepresented parties against represented ones present immense challenges for family law judges. This article discusses the governing law, including the Canons of Judicial Conduct and cases applicable to the scenario, before turning to materials providing guidance for judges, including articles, protocols, guidelines, and bench guides. The article concludes by broadening the frame, since judges do not act in a vacuum. Solutions to the dilemmas facing judges involve not only judicial techniques, but initiatives to ensure that the litigants appearing before the judges are better able to handle their cases and an expansion of the availability of counsel.
The American Bar Association (ABA) 2007 Model Code of Judicial Conduct: What Does it Mean to Juvenile and Family Court Judges?
Authors: Hornsby Thomas E.
Published: February 2011

This article is an examination of the American Bar Association (ABA) Model Code of Judicial Conduct (2007) and codes in states that have adopted the 2007 Code or made revisions based on it. The discussion will be limited to those Canons and Rules that are of concern to juvenile and family court judges in exercising their leadership roles in judicial and extrajudicial duties to help juveniles and their families in and outside the courtroom. Nothing in this article is to be considered the rendering of legal advice. Judges are urged to examine the codes of judicial conduct in their own states.
Business Design: An Indian Idiom
Authors: Mathew Jacob
Published: February 2011

“Where social enterprise meets design thinking and capital to create products and services on a large scale that will be socially equitable, economically sustainable, environmentally sustainable, and culturally connected”—that's the intersection this Bangalore‐based design consultancy aims to occupy.
THE BRAIN BEYOND KÜHN: REFLECTIONS ON ANATOMICAL PROCEDURES, BOOK IX
Authors: ROCCA JULIUS
Published: February 2011

Reliquium noni una cum decimo, undecimo, duodecimo, tertio decimo, quarto decimo, et quinto decimo, etiam in Graecis exemplaribus desideratur.
Drug utilisation research
Authors: Cooke Jonathan
Published: February 2011

Drug utilisation research is a multidisciplinary activity which is now seen as a valuable component of quality assurance wherever medicines are used. This article explains what the research involves and outlines its future applications.
Problems with medicines use: The Bolton project
Authors: Forbes A J , Ross A J , Rees J A
Published: February 2011

The overall results are reported from a project designed to identify the type and frequency of problems associated with the use of medicine by the general public, and to establish any differences between the inner urban area and the rest of the borough of Bolton, England. Two separate groups in the community have been identified who need assistance with medicines. One group, referred by health care professionals, need extensive support and supervision of their medicines. The other group, identified by postal questionnaire, exhibit specific problems, such as difficulties with medicine packaging, general use and storage problems. All could be resolved, to varying degrees, by the intervention of pharmacists.
Pharmacy resource management — three methods to assess individual patient drug costs
Authors: Berns Nicola J , Bass Janet E , Bateman David N , Longshaw Rodney N
Published: February 2011

Resource management has important implications for pharmacy, and methods of costing drugs to individual patients require evaluation as part of this approach. Three systems of allocating medication costs to individual patients have been examined in a study over a year on one medical and one surgical ward at Freeman hospital, Newcastle upon Tyne.

These systems were investigated in three phases: (i) calculation of average cost per bed occupied day, using existing data; (ii) retrospective collection of data from prescription charts; (iii) data capture at the time of administration.

The first approach gave variable and insensitive data about medication costs. Although having little effect on workload, it had no clear potential for resource management.

The second phase evaluated two methods for calculation of drug costs from medication records after discharge. The system accounted for less than 70 per cent of drug costs, and poor staff acceptability, and was time-consuming to administer with no additional benefits.

The third phase captured data via lightpens, with bar codes identifying patient and drug. Between 66 per cent and 93 per cent of issues were recorded accurately by this system.

Advantages included computerised ordering with subsequent time-savings and improvement in stock control. The system has clear potential for use in clinical audit and drug utilisation review
Broadening the research base
Authors: Helling D K , McElnay J C
Published: February 2011

International collaboration is needed
How do ward pharmacists spend their time?: An activity sampling study
Authors: Jenkins D , Cairns C , Barber N
Published: February 2011

A regular clinical pharmacy service to wards is well established in Britain, yet there has been little practice research in this area. In this study, we established how pharmacists distribute their time between different activities on all the wards. All 28 pharmacists in two London hospitals were observed. The observer recorded their activities at one minute intervals and categorised the activity. Thirty-three hours and five minutes of observations were made. The pharmacists visited a total of 55 wards, and checked 982 drug charts.

The major activities were prescription monitoring, which accounted for 31 per cent ± 2 per cent, of the time (mean of pooled data ± 95 per cent confidence intervals), travel to wards 21 per cent ± 2 per cent, stock control 12 per cent ± 1 per cent, transcription 8 per cent ± 1 per cent and clinical monitoring (such as checking giving sets) 7 per cent ± 1 per cent.

The proportion of time spent on each activity was very similar between the two sites, except for the category “transcription”, which took 11 per cent ± 2 per cent of the time in one hospital, where all discharge prescriptions were transcribed onto ward pharmacy sheets (allowing processing in the pharmacy without the need for drug charts to leave the ward), and 3 per cent ± 1 per cent at the other site, in which they were not transcribed.

These results demonstrate that, when on the ward, pharmacists spend the majority of their time in a clinical role. The methodology is simple to use and appears reproducible. This work, if repeated locally, could be used to highlight areas of inefficiency, and could be used to test and predict the impact of other methods of delivery of clinical pharmacy.
Evaluation of an erythropoietin dosing nomogram in continuous ambulatory peritoneal dialysis patients
Authors: Bailie G R , Hamilton R A , Eisele G
Published: February 2011

The ability of a published nomogram to predict doses of erythropoietin was studied in eight continuous ambulatory peritoneal dialysis patients with anaemia. The actual doses given to the patients to produce a steady state haematocrit was compared with the doses predicted by the nomogram. In addition, using described equations, individual erythrokinetic parameters of bone marrow sensitivity (S), red blood cell life (T), and the production of new red blood cells per day (NPe) by marrow, were calculated and compared with population averages in the literature. The actual doses given (50.4 ± 24.4 units/kg three times a week) were not significantly different from the predicted doses (53.2 ± 9.1). The calculated erythrokinetic values were: S = 0.0028 ± 0.0021 ml/unit; T = 72 ± 29 days; NPe = 0.144 ± 0.068 ml/kg/day. There was no consistent over- or under-dosing, but the large variability in nomogram doses and erythrokinetic parameters suggest a limited applicability of the nomogram.
An audit of thrombolysis and adjunct drug use in acute myocardial infarction
Authors: McGlynn S , Matanjun D C
Published: February 2011

This study looked at outcomes of acute myocardial infarction patients following administration of streptokinase or alteplase. For 150 patients (155 thrombolytic drug administrations), the median time delay between onset of symptoms and thrombolytic therapy was 3.6 hours. Only 65 per cent of streptokinase-treated patients tolerated the recommended dose, compared with 85 per cent of those treated with alteplase. Aspirin usage was uncommon (9 per cent) prior to admission but rose to 68 per cent on discharge. However, β-blocker usage only increased from 16 per cent to 24 per cent. Parenteral and oral anticoagulant usage was numerically greater in the alteplase group. There was no significant difference between streptokinase or alteplase in the incidence of any observed adverse effects. There were no allergic type reactions in the alteplase group. The incidence of such reactions in the streptokinase group was not affected by pre-treatment with anti-allergy drugs. Patients in both thrombolytic drug groups experienced similar falls in blood pressure but severe hypotension was more common in the streptokinase group.
Academic pharmacy practice units: Their development and role in England
Authors: Wolfson David J
Published: February 2011

The benefits to be gained from closer relationships between academia and practice were given official endorsement in Britain in the independent Nuffield report into pharmacy and in a circular issued by the Department of Health. Hospital based academic pharmacy practice units (APPUs) were recommended. This paper examines the planning and development of such units and the threats and opportunities presented. The experiences gained in directing a hospital-based unit serving a complete region (Mersey) are provided. Nationally it is shown that APPUs differ in rate of development, organisational structure, relationships and financial support. Their differences are outweighed by their common purpose to improve pharmacy practice by linking academia and practice.
Patients' views of computerised pharmacy records
Authors: Britten Nicky , Gallagher Kenneth , Gallagher Helen
Published: February 2011

There is public support for patient medication records (PMRs). A sample survey showed that a large majority of customers in four pharmacies are in favour of computerised record keeping. The majority of respondents endorsed specified advantages of the use of PMRs, including ensuring that the prescription is correct and avoidance of incompatible medicines
A survey of the use of analgesia in newborn intensive care
Authors: Rutter N , Richardson J
Published: February 2011

The use of analgesia and sedation in 70 United Kingdom units which practise newborn intensive care was examined by questionnaire. Sixty-one units (87 per cent) responded. Fifty-nine per cent of units used drugs for this purpose very commonly (more than once a week) and 26 per cent used them commonly (more than once a month). The commonest indication was to provide analgesia and/or sedation during mechanical ventilation, but drugs were frequently used in post-operative pain relief, in necrotising enterocolitis, for fractures and in meningitis, as well as for several less common indications. Opiates were widely used, particularly morphine (77 per cent of units), diamorphine (31 per cent), fentanyl (16 per cent) and pethidine (16 per cent). They were administered by bolus injection or continuous infusion, usually intravenously. The range of doses used, especially for morphine and diamorphine, was wide and adverse effects (cardiovascular, respiratory, bowel and bladder) were commonly reported (48 per cent). Non-opiate drugs, especially chloral hydrate and paracetamol, were commonly used, too; adverse effects were rarely reported. There is a need to examine the most effective and safest ways of adminstering analgesia and sedation, particularly opiates, to the newborn.
Routine urinalysis on admission: time to review the hospital policy
Authors: Mayne P D , Sutters C A , Lewis M , Ball S G
Published: February 2011

Routine urinalysis is common practice on hospital admission, to screen for the presence of occult disease. It is frequently performed by nurses and the results recorded in the patient's notes. A questionnaire to hospital doctors identified that few knew exactly which tests were performed or where the results were recorded. Only 70 per cent of patients actually had urinalysis performed at the time of admission and, for these, abnormal findings rarely altered patient management. Quality assurance was unsatisfactory in that few nurses adhered to the manufacturer's instructions with respect to timing and the results obtained were qualitatively different from those which were obtained in the laboratory. This study highlights the importance of audit in order to assess the contribution of different groups of hospital staff to effective urinalysis on admission. These groups include the nursing staff who perform the test, doctors who make decisions on the basis of results obtained, clinical chemistry laboratories which provide quality assurance, and pharmacy departments which purchase and supply urine testing sticks.
Preparing medicines in Dutch pharmacies
Authors: Zuidema J , Cox H L M , Bolhuis G
Published: February 2011

A high proportion are made on the premises
Heparin administration using prefilled syringes or ampoules: a comparative cost-effectiveness study
Authors: Barber Nicholas D , Hoffmeyer Ullrich K
Published: February 2011

Heparin is commonly administered for prophylaxis of thromboembolism in a dose of 5,000iu in 0.2ml subcutaneously twice or three times daily. The presentation may be as a prefilled syringe or as an ampoule. The effect of the presentation on nursing time and the true costs involved has been studied in two London hospitals. Thirty-eight administrations from prefilled syringes and 27 from ampoules were recorded. The mean times to prepare and administer the dose and dispose of the equipment were 67.6 seconds for a prefilled syringe and 128.5 seconds for an ampoule; the mean time saving per dose (95 per cent confidence intervals) was 60.9 (40.8, 80.9) seconds. The total cost per dose using a prefilled syringe was 104p; using an ampoule it was 113p. A generic cost model was created. The use of prefilled syringes saved approximately one minute of time and 9p (8 per cent) in cost per administration.
Electronically produced information leaflets increase patients' understanding of antibiotics
Authors: Peura S , Klaukka T , Hannula A-M , Eerikäinen S
Published: February 2011

The effects of electronically produced patient information leaflets on the understanding of and compliance with antibiotic medication were studied in 15 pharmacies in Finland. The study subjects (n=500) were randomly divided into two groups, the control group receiving only verbal information and the intervention group receiving both verbal and electronically produced written information. A few days later the participants were interviewed by telephone. In the intervention group the patient's understanding about the proper use and adverse effects of the medication was better than in the control group. Enhanced awareness of possible adverse effects of the medication did not lead the patients in the intervention group to interrupt their antibiotic medication. Electronically produced written material is easy to administer, and it can be an important counselling aid for pharmacists.
Liposomes for drug delivery: developments and possibilities
Authors: Taylor Kevin M G , Craig Duncan Q M
Published: February 2011

The ability to target a drug specifically to its site of action has long been a goal in therapeuties. Liposomes (phospholipid vesicles) have been investigated as a means of achieving such selectivity and of prolonging the duration of drug activity. With reference to current and future clinical applications, this article outlines why liposomes are appropriate vehicles for drug delivery and describes the possible further development of liposome-based pharmaceutical formulations.
“Mental mirrors” of pharmacists: How do pharmacists perceive their over-the-counter customers?
Authors: Lilja John , Larsson Sam
Published: February 2011

The aim of this study was to analyse how a sample of Finnish pharmacists perceived a number of video-taped customers requesting over-the-counter medicines. The conceptual basis of the study was cognitive psychology.

Eleven female pharmacists took part in the study. In a questionnaire, each pharmacist was asked how she perceived each customer and to say what information she would have given the customer if time was available in the pharmacy. This was followed by a set of questions to which the pharmacist responded by using the ordinal scales provided.

The data were analysed by a combination of qualitative and quantitative methods. The reaction to a specific situation was found to vary considerably among the pharmacists and was influenced by the cognitive structures of the pharmacist, the perceived personal qualities of the customer and the situation. The pharmacists indicated that they would give health information to complement information about the OTC preparation if time was available. Customers who were presumed to be independent would be given more information about side effects and alternative preparations than other customers.
Droperidol with patient-controlled analgesia
Authors: Bishop L , Madej T H , Wheatley R G , Jackson I J B , Blackburn A
Published: February 2011

The addition of droperidol 5mg to the first 50ml of morphine 1mg/ml was compared with morphine alone in 60 patients receiving postoperative analgesia via a patient-controlled analgesia (PCA) system. All patients underwent an abdominal hysterectomy and had a standard anaesthetic which included 2.5mg of droperidol. They were followed up daily for three days postoperatively. The PCA with additional droperidol group received half the number of supplementary antiemetic doses (P<0.05). There was no difference in the incidence of emetic sequelae or reported side effects. Prophylactic droperidol with PCA morphine reduces the need for further intramuscular antiemetic treatment.
Comparison of salbutamol inhalers available in the United Kingdom
Authors: Lee M Gerard , Ireland Denis S , Dwyer Paul J , Weir Philip J
Published: February 2011

A comparative assessment of salbutamol inhalers has shown that all licensed products currently available in the United Kingdom comply with the British Pharmacopoeia monograph for salbutamol pressurised inhalers and that there are no clinically significant differences between the various generic brands. Differences were observed between the colours of the inhalers which may cause confusion for patients. Generic manufacturers have been advised of this and say that they will be altering the design and appearance of some brands to ensure that the colour of the inhaler and the design of the mouthpiece will be consistent.
Response to dysmenorrhoea: An assessment of pharmacists' knowledge and its application in practice
Authors: Anderson Claire , Alexander Angela
Published: February 2011

A combination of covert participant observation and semi-structured interviews was used in 65 pharmacies to assess pharmacists' skills and knowledge in their response to the symptom of dysmenorrhoea. The pharmacists were found to ask too few questions; 12 per cent asked no questions. Over half the pharmacists did not recommend the product of choice. Few pharmacists adopted a structured approach when responding to the symptom. The disappointing results could relate to a number of factors, one of which, inadequate training, was cited in the interviews.
Home intravenous antibiotic therapy
Authors: Littlewood Alison
Published: February 2011

Why is Europe lagging behind the United States in the development of this type of therapy?
Hospital clinical pharmacy services provided to primary care
Authors: Cotter Siobhan M , Barber Nicholas D , McKee Martin
Published: February 2011

Recent changes in the United Kingdom national health service (NHS) have increased the need for pharmacy services in primary care. Government documents have advocated a role for hospital pharmacists in the provision of clinical pharmacy services to primary care. A census survey was carried out to establish the extent to which hospital pharmacists have become involved in the provision of clinical pharmacy services to primary care patients and health professionals. Questionnaires were sent to district pharmaceutical officers in England (and their equivalents in the rest of the UK). One hundred and ninety-three questionnaires were returned (92 per cent). Hospital pharmacists provided few advisory, educational or information services to patients and primary care health professionals, with the exception of primary care nurses. Pronounced variations in service provision were observed in different parts of the UK. Respondents gave reasons for their limited involvement and indicated that the provision of services is increasing.

The survey shows that government policy on the provision of hospital clinical pharmacy services to patients and health professionals in primary care has not been implemented. The provision of such service is, however, increasing, mainly as a consequence of the NHS reforms and the movement of resources to primary care.
Formulation and stability of pilocarpine oral solution
Authors: Fawcett J P , Tucker I G , Davies N M , Ferguson M M
Published: February 2011

The stability of four formulations of pilocarpine oral solution containing glycerol, hydroxybenzoate preservatives and lemon spirit was studied on storage for 90 days at 4, 25 and 38C using a stability-indicating high performance liquid chromatography assay. The solutions were prepared from pilocarpine hydrochloride powder (0.2 and 3mg/ml) in citrate buffer pH 5.5, or from eyedrops (3mg/ml) in citrate buffer pH 5.5 or phosphate buffer pH 7.5. Significant decomposition of pilocarpine occurred in the pH 7.5 formulation at all three temperatures. The data were adequately described by a first order model. Degradation in the pH 5.5 formulations was not significant over 90 days at 4C or 60 days at 25C. Decomposition at 38C was significant and adequately described by a zero order model. The lower 95 per cent confidence limits for 10 per cent decomposition were 36 days for the eye-drop formulation and 27 and 32 days for the 0.2 and 3mg/ml powder formulations respectively. Pilocarpine oral solution prepared from powder or eye-drops in pH 5.5 buffer is chemically stable for 60 or 90 days at 25C or 4C, respectively, and provides a stable dosage form.
Pharmacists: A resource for general practice?
Authors: Bond Christine M , Sinclair Hazel K , Taylor Ross J , Duffus Peter , Reid John , Williams Arthur
Published: February 2011

A postal questionnaire seeking the views of all Grampian general practitioners (n=314) to a proposed wider role for pharmacists obtained an 85 per cent response rate. The questionnaire consisted of prescribing related and general tasks compiled from the recommendations of the joint working party's report “Pharmaceutical care: the future for community pharmacy” and those identified by a local GP and pharmacist while working on a joint study.

The overall opinion of GPs was in favour of increasing the role of pharmacists. They were most likely to support a routine service for the disposal of unwanted medicines, provision of compliance aids under the NHS and a formal system for pharmacists to report adverse drug reactions. GPs were least likely to support the selection of medicine and dosage by a pharmacist following agreed protocols, an NHS funded pharmaceutical adviser within surgeries to counsel patients on the use of medicines, or the provision of diagnostic and screening services by pharmacists. It is concluded that there is a potential for the integration of the community pharmacist within the traditional primary health care team. Roles have been identified that are acceptable to GPs and which could bring job satisfaction to pharmacists, whose specialist knowledge of drugs is currently under-utilised.
Comparison of conventional metered dose inhaler and breath actuated inhaler in elderly patients
Authors: Hendry A , Coote J , Black H , Duncan G , MacDonald J B
Published: February 2011

Elderly patients frequently fail to achieve or to retain a competent inhaler technique using a conventional metered dose inhaler. In a prospective, randomised, crossover study of 44 subjects aged 64–94 (mean 78) years, we compared a metered dose inhaler (MDI) with a breath actuated inhaler (BAI) in terms of inhaler technique, ease of teaching and patient acceptability. Patients were stratified according to physical, functional or cognitive impairment before randomisation. Structured tuition was provided at the start of treatments, and technique was graded weekly and retaught if deficient. At the start of the treatment periods satisfactory technique was observed in 14 of 35 patients (six impaired, eight unimpaired) using the MDI and in 14 of 35 patients (three impaired, 11 unimpaired) using the BAI (P = 1.0). At the end of the four-week treatment periods satisfactory technique was observed in 19 of 30 patients (seven impaired, 12 unimpaired) using the MDI and in 27 patients (11 impaired, 16 unimpaired) using the BAI (P = 0.01). Mean weekly teaching times (minutes) were similar (MDI 7.0, BAI 6.5, P = 0.41) and there was no difference in terms of patient acceptability (P = 0.38). A breath actuated inhaler may be the preferred device for elderly patients as a greater proportion were able to retain satisfactory inhaler technique.
Risk reduction methods for self treatment
Authors: Charupatanapong Nawarut
Published: February 2011

Face to face interviews with consumers at shopping mails in Houston, Texas, sought to evaluate the helpfulness of nine risk reduction methods for self-treatment of three selected health problems (minor eye problems, overweight, and indigestion). Professional advice provided by pharmacists and loyalty to a brand used previously were rated as the two most helpful methods for self-treatment of all three health problems. There were no significant differences found in the evaluation of the nine risk reduction methods across any demographic factors for either overweight or indigestion. For minor eye problems, respondents who were separated, divorced or widowed rated the “shopping-around” and comparing brands more helpful than did those who were engaged. Those who had self-treating experience with overweight and indigestion rated brand loyalty more helpful than those who did not have any self-treating experience.

Overall, professional advice provided by pharmacists was rated as the most favourable risk reduction method for self-treatment for all three selected health problems. Consumers' self-treating experience may have an impact on their evaluation of the risk reduction methods.
Ward pharmacy services — is a once daily visit less efficient than a twice daily visit?
Authors: Beech E F , Barber N D
Published: February 2011

Ward pharmacy services are widely provided in hospitals throughout the United Kingdom. The objective of this study was to compare the efficiency of once daily with twice daily ward visits. Over a two week period, eight matched wards — four providing a twice daily service and four a once daily service — were assessed in three areas: time taken to provide the service, clinical pharmacy activity, and supply of non-stock items. A total of 120 ward pharmacy visits occurred during the 10 day study period. The mean total daily ward visit time was 55 minutes in the twice daily group compared with 40 minutes in the once daily group, a difference of 15 ± 7.6 minutes/ward/day. Pharmacists in the once daily group spent 52 per cent of time on clinical pharmacy activities and recorded 169 prescription monitoring incidents (PMIs). In comparison, pharmacists in the twice daily group spent proportionally less time on clinical pharmacy activities (42 per cent) and recorded significantly fewer PMIs (107). The proportion of non-stock items originating from the ward pharmacy service was similar in both groups. This study found a once daily ward pharmacy service more efficient than a twice daily service, saving an average of 15 minutes/ward/day.
Ethnic minority consumers of community pharmaceutical services
Authors: Jesson J , Sadler S , Pocock R , Jepson M
Published: February 2011

A survey carried out by the authors in the West Midlands area of England found that use of, and access to, community pharmaceutical services appeared to be lower among ethnic minority customers than in the majority population, although their needs were probably higher. The survey has been published in full elsewhere. In this article, the authors summarise the main results of their survey, and compare these with the results from a similar study involving respondents predominantly from the white population. They also discuss some of the methodological difficulties in carrying out research into ethnic minority health issues.
General medical practitioners' attitudes towards the use of patient medication records
Authors: Rogers Philip J , Rees John E
Published: February 2011

A survey was conducted to ascertain general medical practitioners' (GPs') attitudes to community pharmacists' use of patient medication records (PMRs) and to assess whether GPs envisage a role for family health service authorities (FHSAs) in maintaining records of patients' data.

The survey questionnaire was sent by post to all 1,257 GPs in contract with Avon and Devon FHSAs. A total of 811 questionnaires was returned, an overall response rate of 64.5 per cent. A majority (59 per cent) of GPs considered that community pharmacists should keep patient medication records and there was strong support for pharmacists holding PMRs for the elderly and confused, and also for patients with diabetes, asthma, epilepsy, and those patients who had experienced major adverse drug reactions or allergies. Some GPs, however, remained unconvinced of the usefulness of a pharmacy PMR. Seventy four per cent of respondents considered that patients should keep their own medication records. In contrast, only 4 per cent were in agreement with patient medication data being stored by FHSAs. The community pharmacist's role in maintaining PMRs received less support from doctors in dispensing practices than from their non-dispensing counterparts. Some 80 per cent of respondents were in favour of pharmacists providing PMR system-generated patient information leaflets with dispensed medicines. Most GPs considered that such leaflets had a positive effect on patient compliance. Recently registered GPs were found to be more supportive than their older colleagues of community pharmacists recording patients' clinical conditions and providing information leaflets.
Stability of ipratropium bromide and salbutamol nebuliser admixtures
Authors: Jacobson Glenn A , Peterson Gregory M
Published: February 2011

The physicochemical stability of an admixture of ipratropium bromide and salbutamol nebuliser solutions, 1:1 v/v, was determined by storing solutions for five days in a refrigerator at 4C, at 22C protected from light and at 22C under 24 hour fluorescent lighting. Concentrations of ipratropium and salbutamol were periodically determined using a high performance liquid chromatography assay. The nebuliser solution admixtures retained greater than 90 per cent of their original concentrations of ipratropium and salbutamol for the duration of the study. Differences in losses between storage conditions were not statistically significant.

Admixtures of proprietary ipratropium bromide and salbutamol nebuliser solutions (1:1 v/v) retain greater than 90 per cent of their initial concentrations if stored between 4C and 22C for periods of up to five days. An expiry period of five days for these admixtures would seem reasonable in practice.
Stability of epidural opiate solutions in 0.9 per cent sodium chloride infusion bags
Authors: Grassby Paul F , Roberts David E
Published: February 2011

The stability of pethidine 2.5mg/ml, and of a mixture of bupivacaine hydrochloride 1.25mg/ml and diamorphine hydrochloride 125μg/ml, in 500ml 0.9 per cent sodium chloride infusion bags was determined. Samples of the solutions were stored uncovered at room temperature, exposed to natural and artificial light, for 24 and 28 days, respectively. No colour change, crystallisation or precipitation was observed, and although the mean pH of the bupivacaine and diamorphine mixtures increased slightly, the mean pH of the pethidine samples remained essentially unchanged. The only significant (P < 0.05) change in potency was a reduction in diamorphine concentration by a mean of 8.22 per cent after 28 days, which is in accordance with other reports on diamorphine degradation.

Thus pethidine 2.5mg/ml in 500ml 0.9 per cent sodium chloride infusion bags is stable for at least 24 days at room temperature, and a mixture of bupivacaine hydrochloride 1.25mg/ml and diamorphine hydrochloride 125μg/ml in 500ml 0.9 per cent sodium chloride infusion bags is stable (less than 10 per cent loss of potency) for 28 days at room temperature. Both these solutions could, therefore, be prepared in pharmacy central intravenous additive units and supplied to hospital wards as 500ml infusion bags for use in epidural analgesia following surgery. As each bag would provide nearly three days' worth of analgesic, the risk of infection and the nursing workload should both be reduced.
Cumulative costs of inadvertent excess prescribing on multiple item prescription forms
Authors: Rees J A , Collett J H , Asher D M
Published: February 2011

Prescription forms listing more than one item, ie, multiple item prescriptions, may be termed non equivalent if the number of days' treatment prescribed for each of the drugs is different. Patients presenting such prescriptions at 15 community pharmacies were identified and records maintained of all prescriptions presented by these patients over a nine month period. The total amounts of drugs and number of days' treatment prescribed were identified and costed. A total of 53.5 per cent of the non-equivalent items were for amounts representing between one and five days' excess treatment. Excess treatment represented 13.9 per cent of the total cost of these prescriptions. The estimated national cost of inadvertent excess prescribing for 1991/92, based on a projected calculation, was £60m (2.4 per cent of the total expenditure).
Long term stability of heparin in dextrose-saline intravenous fluids
Authors: Wright Alex , Hecker John
Published: February 2011

In vitro studies showed that heparin added at liu per ml to 5 per cent dextrose solution lost most of its activity during 12 months' storage at both 20 to 25C and 2 to 5C but retained its activity when added to normal saline and to a 3.75 per cent dextrose-saline mixture at these temperatures. Activity of 10iu per ml of heparin in 5 per cent dextrose solution was retained at 20 to 25C for 12 months. These findings suggest that low-dose heparin is stable for long periods in dextrose-saline but not in dextrose solutions