bluuebunny/crossref_metadata_2025_split huggingface dataset:
Errors with Injectable Medications: Unlabeled Syringes are Surprisingly Common; Unintended Consequences of High-Alert Stickers; Easily Misread Abbreviations
Authors: Cohen Michael R. , Smetzer Judy L. 
Published: May 2010

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices (ISMP). If you have encountered medication errors and would like to report them, you may call USP tollfree, 24 hours a day, at 800-233-7767 (800-23-ERROR). Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or United States Pharmacopeia (USP) ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.
High-Dose Insulin in the Treatment of Antihypertensive Overdose
Authors: Clark Emily G. , Nykamp Diane L. , Nguyen Vy V. 
Published: May 2010

Objective To describe a case of calcium channel blocker overdose along with an angiotensin-converting enzyme inhibitor and angiotensin receptor blocker, which was successfully treated with high-dose insulin with dextrose and potassium supplementation (HDIDK). Case Summary A 52-year-old woman was transferred to an admitting hospital after ingesting 14 tablets of trandolapril/verapamil SR ( Tarka)4 mg/240 mg, 15 to 16 tablets of olmesartan ( Benicar) 20 mg, and an unknown amount of (escitalopram) Lexapro combined with unknown quantities of alcohol and benzodiazepines. This combination caused hypotension and electrocardiogram changes. The patient was treated for hypotension-induced shock with epinephrine, glucagon, HDIDK, magnesium, and fluids. An insulin infusion ran for 24 hours. The patient was discharged to a psychiatric facility 3 days after admission. Discussion The non-dihydropyridine, verapamil, causes dilation of the coronary and peripheral vasculature by inhibiting the influx of calcium ions through L-type calcium channels. HDIDK is thought to be a useful treatment in the state of hypoinsulinemia, which prevents the uptake of glucose by myocytes and can lead to decreased inotropy and eventually shock. High-dose insulin allows glucose to be properly used for energy by the myocytes. Conclusions Currently HDIDK therapy is recommended as an adjunct to conventional therapy in calcium channel blocker poisoning only after fluids, high-dose calcium salts, and vasopressors. In this case, early implementation of HDIDK treatment was shown to shorten the length of therapy.
Stability of Levalbuterol in a Mixture of Levalbuterol and Ipratropium Nebulizer Solution
Authors: Yamreudeewong Weeranuj , Teixeira M. Glaucia , Mayer Gabriele E. 
Published: May 2010

Levalbuterol hydrochloride ( Xopenex) inhalation solution is a short-acting bronchodilator, which was approved by the United States Food and Drug Administration for the treatment or prevention of bron-chospasm in adults and children 6 years of age and older. Levalbuterol is also a (R)-enantiomer of racemic albuterol. Because of the lesser dose required for bronchodilatory effect, levalbuterol may cause less cardiovascular adverse effects, such as tachycardia, than racemic albuterol. The stability of levalbuterol in the mixture of levalbuterol and ipratropium nebulizer solution was studied. At 0, 1, 2, 6, 24, 48 hours and 5, 7, 14, and 28 days, 150 mcL of this mixture was combined with 1.5 mcL of internal standard solution (mepivacaine 5 mg in 1 mL of distilled water) and injected into the high-performance liquid chromatography (HPLC) system. Injections were done in triplicate and the concentrations for levalbuterol and ipratropium calculated using a calibration curve. The concentration of each drug was found to be within the acceptable limit (± 10% of the initial concentration) in all test samples. The levalbuterol and ipratropium mixture was stored at room temperature during the study period. Over the time period of 28 days at room temperature, no significant decrease in concentrations could be detected for levalbuterol or ipratropium.
Hydroxyethyl Starch 130/0.4
Authors: Cada Dennis J. , Levien Terri , Baker Danial E. 
Published: May 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 your Pharmacy & Therapeutics Committee. Subscribers also receive monthly 1-page summary monographs on the 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 to you in print and are also available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The May 2008 monograph topics are sugammadex, desvenlafaxine succinate extended-release, rilonacept, progesterone vaginal insert, and fospropofol disodium. The DUE is on ciclesonide inhalation aerosol.
Evaluation of Pharmacist-Managed Education of Medical Residents
Authors: Liles Anne Marie , Kelley Kristi 
Published: May 2010

Purpose The purpose of this study was to determine the effectiveness of presentations provided by pharmacists/pharmacy students in increasing medical residents' knowledge of treatment options and guidelines of various disease states. A secondary objective was to evaluate medical residents' satisfaction and perception of increased knowledge. Methods A series of presentations were conducted by pharmacist/pharmacy students in an internal medicine resident clinic. Topics covered included dyslipidemia, hypertension (HTN), and asthma. Prior to each presentation, medical residents completed a pretest. One to 3 weeks after the presentations, residents were asked to complete a post-test identical to the pretests. At the conclusion of the series, medical residents responded to a follow-up survey that assessed the residents' perception of the usefulness of the presentations and interest in future presentations. Results Twenty medical residents attended the dyslipidemia presentations and completed a pretest with 18 of these residents completing a post-test. The overall increase in median score was 7%. Twelve residents attended the HTN presentations and completed a pretest with 11 of these residents completing a post-test. The overall increase in median score was 17%. Thirteen residents attended the asthma presentations with 10 of these residents completing a post-test. The overall increase in median score was 3%. Seventeen residents completed the follow-up survey with “agree” being the most common response to all items indicating satisfaction and perception of increased knowledge. Conclusion There was an overall improvement in pharmacotherapy knowledge of medical residents as anticipated. Residents were satisfied with the presentations and perceived an increase in their pharmacotherapy knowledge.
Improving Heparin Safety: A Multidisciplinary Invited Conference
Authors: Peterson Carl , Ham Charles W. , Vanderveen Tim 
Published: May 2010

Heparin is widely used in a variety of settings for prevention and treatment of thromboembolic events. Data from a number of sources indicate that it is also one of the drugs most frequently associated with adverse events and medication errors, many of which are serious. National media attention has focused on recent events involving heparin and The Joint Commission has included heparin in its 2009 National Patient Safety Goal to reduce patient harm from anticoagulants. Heparin safety is on the national agenda and health care organizations are struggling to improve it. Health care providers in clinical, management, and executive roles must work together to improve heparin safety. Over 40 anticoagulation experts and practitioners came together in San Diego on March 13 through 14, 2008 to share information, offer perspectives, and address issues on the topic improving heparin safety. These individuals represented The Joint Commission, United States Pharmacopoeia, the Institute for Safe Medical Practices, academic institutions, large health care systems, and small hospitals who participated in a day and a half of presentations and round-table discussions. This article summarizes 21 presentations with a primary focus on types and frequency of heparin errors as well as identified opportunities to improve heparin safety. The conference was sponsored by Cardinal Health's Center for Safety and Clinical Excellence.
Thrombin, Topical (Recombinant)
Authors: Cada Dennis J. , Levien Terri , Baker Danial E. 
Published: May 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 your Pharmacy & Therapeutics Committee. Subscribers also receive monthly 1-page summary monographs on the 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 to you in print and are also available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The July 2008 monograph topics are on subcutaneous methylnaltrexone bromide, certolizumab pegol, regadenoson injection, olopatadine hydrochloride nasal spray, and triamcinolone acetonide injectable suspension. The DUE is on subcutaneous methylnaltrexone bromide.
Avoid Confusion with Torisel Dose Preparation; Remove Vials from Cartons; Sumatriptan Confused with Sitagliptin; Misdispensing of Purinethol Instead of Propylthiouracil: A Preventable Disaster
Authors: Cohen Michael R. 
Published: May 2010

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the United States Pharmacopeia (USP) Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices (ISMP). If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800–233–7767 (800–23-ERROR). Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.
ABCs of ABGs: A Guide to Interpreting Acid-Base Disorders
Authors: Wargo Kurt A. , Centor Robert M. 
Published: May 2010

Purpose This objective of this article is to provide a useful resource on the assessment of arterial blood gasses (ABGs) for clinical pharmacists, pharmacy residents, and students. Summary Acid-base pathophysiology can be separated into metabolic or respiratory acidosis and alkalosis, as well as those disturbances that are compensated. This article provides readers with a stepwise approach for assessing ABGs, as well as offering actual case examples to familiarize the reader with the concepts of acid-base disorders. By the completion, the reader will have the tools necessary to assess any ABG that may be encountered in clinical practice. Conclusion Comprehension of acid-base pathophysiology is a complicated and overwhelming task for novice and experienced clinicians alike. Utilization of the stepwise approach proposed in this article will help clinicians at all levels of training assess and develop treatment options for any acid-base disturbance encountered in practice.
Intraventricular Colistin for the Treatment of Multidrug-Resistant Pseudomonas Aeruginosa Shunt Infection
Authors: Dixon Kelly S. , Hassoun Ali 
Published: May 2010

Purpose To report a case of ventriculoperitoneal shunt (VPS) infection with multidrug-resistant (MDR) Pseudomonas aeruginosa infection treated successfully with intraventricular colistin. Summary A 56-year-old black woman with a known history of sub-arachnoid hemorrhage and hydrocephalus necessitating VPS placement experienced fever, headache, and neck pain several weeks after she underwent emergent colectomy with ileostomy for Clostridium difficile colitis. Fever and neck stiffness were significant on examination. The patient's laboratory data demonstrated elevated cerebrospinal fluid (CSF) white blood cell count and protein level. A culture of the CSF grew P. aeruginosa and Enterococcus faecalis. Despite multiple antibiotic regimens and removal of the shunt, the CSF cultures continued growing P. aeruginosa. Intraventricular colistin was initiated as monotherapy, and colistin successfully sterilized the CSF within 24 hours. The patient developed severe headache and confusion, which her physicians thought was colistin-induced arachnoiditis; this condition resolved rapidly on discontinuation of therapy. Discussion The emergence of MDR, gram-negative microorganisms is a major concern for health care professionals worldwide. The rapid appearance of these organisms has led to a concurrent increase in central nervous system (CNS) infections caused by such bacteria. Furthermore, the clinical value of antibiotics that remain active against MDR, gram-negative bacteria in the CNS is limited by their decreased penetration of the blood-brain barrier. There is a revived interest in the use of intrathecal or intraventricular colistin to ensure adequate drug concentrations at the site of infection. Conclusion Intrathecal or intraventricular administration of colistin appears to be an appealing therapeutic option for CNS infections, especially in life-threatening emergencies. Further studies are needed to clarify the role of intrathecal colistin for treating MDR, gram-negative CNS infections.
Impact of Pharmacy-Generated Recommendations on Antibiotic Therapy in a Community Hospital
Authors: Steinberg Jennifer G. , Machado Caridad , Clarke Heidi , Marsh Wallace A. , Kelly Gloria 
Published: May 2010

Purpose To examine the impact of a pharmacy-initiated antibiotic review service on the appropriateness of antibiotic therapy at a community hospital. Methods A retrospective review was conducted that assessed antibiotic prescribing before implementation of an antibiotic review service, followed by an interventional phase that assessed the impact of pharmacy-generated recommendations. Medical records were evaluated for appropriateness of antibiotic therapy. For records reviewed retrospectively, potential recommendations for improvement of antibiotic appropriateness were documented. Potential recommendations were based on evidence-based practice guidelines and pertained to organism susceptibilities, renal dosage adjustments, intravenous-to-oral conversion, duplication, duration, and indication for therapy. During the interventional phase, recommendations were directed to the prescribing physician via telephone or written communication. Patient charts were revisited regularly to assess for potential new recommendations and to determine acceptance of previous recommendations. Results At initial review, 95 (59%) orders reviewed retrospectively were considered appropriate. A total of 73 potential recommendations for improving appropriateness of retrospective orders were recorded. At completion of follow-up, overall appropriateness of retrospective orders decreased to 57%. Prospectively, 115 (57%) orders were considered appropriate at initial review. Physicians accepted 39 (71%) of the 55 recommendations generated for improving appropriateness of these orders. Pharmacy-generated recommendations were successful in improving the number of appropriate prospective orders by 13% ( P = 0.004) and identified a cost savings of approximately $12,000. Conclusion The pharmacy-initiated antibiotic review service has been well accepted by physicians and appears to have a positive impact on the number of appropriately prescribed antibiotic orders. Complete implementation of this review service may demonstrate greater impact.
Certolizumab Pegol
Authors: Cada Dennis J. , Levien Terri L. , Baker Danial E. 
Published: May 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 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 2008 monograph topics are on granisetron transdermal system, lidocaine HCl ophthalmic gel 3.5%, casopitant, pegloticase, and mepolizumab. The DUE is on granisetron transdermal system.
Evaluation of cell counting and leukocyte differentiation in cerebrospinal fluid controls using hematology analyzers by the German Society for Clinical Chemistry and Laboratory Medicine
Authors: Kleine Tilmann O. , Nebe C. Thomas , Löwer Christa , Lehmitz Reinhard , Geilenkeuser Wolf-Jochen , Kruse Rolf , Dorn-Beineke Alexandra 
Published: May 2010

Abstract

Background: Manual cell counting in cerebrospinal fluid (CSF) is technique-dependent, time-consuming, and thus costly and prone to inter-operator variability and low precision. Flow cytometry (FCM) with fast hematology analyzers (HAs) appears to improve accuracy and precision of CSF cell analysis; rapid CSF cell analysis is especially needed in emergency laboratories. Ten external trials of the German Society for Clinical Chemistry and Laboratory Medicine evaluated FCM with Coulter (LH750, 755), Abbott CD3200™, CD3500™, CD3700™, CD4000™, Sapphire™, ADVIA120® CSF assay, and Sysmex® XE-2100 single platform analyzers.

Methods: CSF controls were produced using native blood leukocytes and erythrocytes, resembling CSF and thus rendering the trials feasible and allowing comparison with native manual counting in a Fuchs-Rosenthal chamber and FACScan-CD45-CD14 dual platform analysis, which was used as the reference method. Statistical evaluation was performed using Passing/Bablok regression analysis.

Results: Our evaluation revealed significant differences with respect to target values in leukocyte and erythrocyte counts, as well as leukocyte differentiation. These differences were attributed to inaccuracies produced by the HAs, due to blank correction in connection with impedance analysis, leukocyte loss, especially through monocyte injury due to the erythrocyte lysing agent, incomplete erythrocyte lysis, ADVIA cell sphering, cell differentiation using algorithms and peroxidase activity. Erythrocyte counting in the CSF controls was inaccurate with the Coulter and ADVIA analyzers.

Conclusions: Evaluation of HAs by means of the CSF controls revealed inaccuracies in cell counting and leukocyte differentiation. Analyzer techniques, used for CSF cell assays, therefore need to be improved.
Clin Chem Lab Med 2010;48:839–48.
Cord blood and maternal serum neopterin concentrations in patients with pre-eclampsia
Authors: Cayci Tuncer , Akgul E. Ozgur , Kurt Yasemin Gulcan , Aydin Ibrahim , Alacam Hasan , Ozkan Esin , Yaman Halil , Cakir Erdinc , Deren Ozgur , Dogan Pakize , Bilgi Cumhur , Erbil M. Kemal 
Published: May 2010

Abstract

Background: Pre-eclampsia is a syndrome characterized by hypertension and proteinuria. The aim of this study was to investigate neopterin concentrations in cord blood and maternal serum in patients with pre-eclampsia and a control group.

Methods: Cord blood and maternal serum neopterin were measured in 21 patients with pre-eclampsia and in 27 control subjects. Neopterin concentrations were measured by high performance liquid chromatography.

Results: Cord blood neopterin concentrations were significantly increased in patients with pre-eclampsia compared to controls (54.3±16.8 vs. 43.4±8.5 nmol/L, p=0.011, respectively). Maternal serum neopterin (257.3±36.8 vs. 150.9±33.8 nmol/L, p<0.001) was also higher in patients with pre-eclampsia.

Conclusions: Cord blood and maternal serum neopterin concentrations are higher in patients with pre-eclampsia. Maternal serum neopterin concentrations used may be used as a marker for the early diagnosis of pre-eclampsia.
Clin Chem Lab Med 2010;48:1127–31.