bluuebunny/crossref_metadata_2025_split huggingface dataset:
True Allergy or Other Symptom?; Too Much Hydromorphone; Patient Safety Increased in Obstetrics; Medication Patch Slips into Incorrect Automated Dispensing Cabinet Pocket; Volume Control Set Safety
Authors: Cohen Michael R. 
Published: February 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.
Therapeutic Interchange Practices among Texas Medical Center Institutions
Authors: Moultry Aisha Morris , Wilmer Sonya R. 
Published: February 2010

Purpose There has been an increase in therapeutic interchange (TI) practices in institutional settings because of the growing number of “me too” drugs and the desire for hospitals to minimize their formularies' economic impact. The Texas Medical Center (TMC) Clinical Pharmacists Task Force conducted a study to determine TI practices at TMC member institutions. Methods The task force members who represented a hospital were polled to determine whether their institution participated in a TI process for medication dispensing. Members who provided a positive response were asked to submit a copy of the institution's policy and/or procedure for review. Each policy and procedure was reviewed to determine the therapeutic classes of agents involved in TI, as well as the preferred agents. Results Of the hospitals involved in the study, 6 reported the presence of policies/procedures for TI practices, and it was found that 3 policies/procedures were common. There were 5 common therapeutic classes of agents involved in TI at all 6 hospitals. Most endorsed the use of cefoxitin or cefepime as the preferred antimicrobial agent. Famotidine was the preferred H2 antagonist, and pantoprazole was the recommended proton pump inhibitor. Simvastatin was the approved alternative for beta-hydroxybeta-methylglutaryl-coenzyme A (HMG CoA) reductase inhibitors, and for all requested angiotensin-converting enzyme inhibitors, lisinopril was the recommended formulary agent. Conclusion Although this project identified some consistency in TI practices, it also recognized inconsistencies in the conversions used for select interchanges; these should be further researched.
Intravenous Infusion Safety Technology: Return on Investment
Authors: Danello Sherry H. , Maddox Ray R. , Schaack Gregory J. 
Published: February 2010

Purpose In 2006 the Institute of Medicine reported that at least 400,000 preventable adverse drug events (ADEs) occur annually among patients being hospitalized, with costs of $3.5 billion (or $8,750 per preventable ADE). Recommended medication error prevention technologies include computerized prescriber order entry, bar-code medication administration, and computerized intravenous (IV) safety systems with dose-error reduction software. When St. Joseph's/Candler Health System replaced its existing IV pumps, the decision to incur the incremental cost for “smart” IV safety systems rather than traditional IV pumps resulted in financial benefits, improved safety, improved quality of care, and increased nursing satisfaction. Methods Electronic data recorded at the bedside as caregivers administered medications provided information from which actual cost avoidance could be more readily calculated and presented objective evidence of the fiscal value of investments in innovative technologies. Results Over a 5-year period, implementation of these smart systems reduced high-risk medication errors and patient-controlled analgesia-related undesired outcomes, helped avert at least 471 preventable ADEs, and provided a 5-year return on investment (ROI) of $1.87 million, with an internal rate of return of 81%. Conclusion Financial analysis of the incremental costs of IV safety systems can help calculate anticipated ROI accurately and better prioritize implementation of these systems.
Febuxostat
Authors: Cada Dennis J. , Levien Terri L. , Baker Danial E. 
Published: February 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 August 2009 monograph topics are tolvaptan, besifloxacin ophthalmic suspension 0.6%, tadalafil, bromocriptine mesylate, and acetaminophen intravenous. The DUE is on tolvaptan.
Insulin Preparation Error by Physician; Should Zosyn Be Available in Automated Dispensing Cabinet Stock?; Medication List Filing Error; Institute for Safe Medication Practices Launches First Self-Assessment of Automated Dispensing Cabinet Safety
Authors: Cohen Michael R. 
Published: February 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.
Institutional Experience with Daptomycin Treatment in Patients with Gram-Positive Infections
Authors: Collins Curtis D. , Desmet Brian D. , Depestel Daryl D. 
Published: February 2010

Purpose Daptomycin was originally approved for the treatment of complicated skin and skin-structure infections caused by gram-positive bacteria, and recently, its indications were expanded to include bacteremia and right-sided infective endocarditis caused by Staphylococcus aureus. This retrospective chart review examines outcomes and costs for individuals treated with daptomycin at a tertiary care medical center. Methods During an 11-month period, records of patients treated with daptomycin at the institution were reviewed. Cases for which complete cost data were available were included in the analysis. Outcomes were assigned to 4 categories: cured, improved, failed, or unevaluable. Hospital stay details were recorded, and antibiotic and total hospital treatment costs were calculated. Results Thirty-five patients representing 37 cases were included in the review. Of those cases, 89% (33 of 37) involved documented infections with gram-positive bacteria, 22% involved confirmed methicillin-resistant S. aureus infections, and 32% involved confirmed vancomycin-resistant enterococcus infections. Most cases (27 of 37; 73%) involved infections with multiple bacterial isolates for which previous therapy had failed. Of all clinically evaluable cases, 54% were classified as cured and 42% as improved after daptomycin therapy. Median and mean ± standard deviation (SD) total cost of hospitalization were $46,730 and $111,604 ± $137,138, respectively. Overall median duration of therapy for all 37 cases was 14 days (range, 1 to 143; mean ± SD duration, 25.5 ± 32 days). Conclusion Daptomycin cured or improved most evaluable gram-positive infections. The results of this study suggest that daptomycin may be considered a therapeutic option for treatment of drug-resistant gram-positive infections.
Anticoagulation Patient Safety Goal Compliance at a University Health System: Methods for Achieving the Goal
Authors: Franco Ana Crystal , Maxwell Pamela , Green Kay , Barthol Colleen 
Published: February 2010

Purpose Outline steps taken at a university teaching health system to meet The Joint Commission's (TJC's) National Patient Safety Goal (NPSG) for anticoagulation therapy. Description The aim of NPSG 3E (recently renumbered as 03.05.01) was to reduce the likelihood of patient harm associated with anticoagulation therapy. Full implementation of a management program for individualization of patient care was required by January 1, 2009. University Health System (UHS) has formed an anticoagulation safety committee consisting of nurses, dieticians, pharmacists, and physicians. Monthly meetings are held to assign projects and responsibilities and to report progress of ongoing tasks. Subcommittees involving selected members have been formed to conduct in-depth evaluations of specific agenda items. The committee has defined target anticoagulants, including unfractionated heparin, enoxaparin, dalteparin, argatroban, lepirudin, fondaparinux, and warfarin. Current practice has been evaluated by gathering baseline adverse events data, performing drug utilization reviews, and analyzing usage. A timeline of progress and expected completion dates for each milestone has been created. Future tasks include developing standard protocols for all anticoagulants and ensuring consistency in discharge counseling. Recently, UHS created a new anticoagulation clinical pharmacist position, and a long-term goal is creation of an anticoagulation team. Responsibilities of this team will include therapy management, discharge counseling, staff education, and maintenance of evidence-based protocols. Conclusion Implementing a program of this caliber to meet TJC's January 2009 deadline for full implementation of a management program posed a challenge to this large teaching institution. This article outlines the steps necessary for ensuring achievement of milestone deadlines.
Impact of a Methicillin-Resistant Staphylococcus Aureus Active Surveillance Culture Protocol on Mupirocin Prescribing
Authors: Segarra-Newnham Marisel , John Kristin St. 
Published: February 2010

Background To identify patients colonized with methicillin-resistant Staphylococcus aureus (MRSA), an active surveillance culture (ASC) protocol has been in place since March 2007. Decolonization with mupirocin ointment is not recommended but may be attempted after a positive MRSA screen. Objective Assess the impact of an inpatient ASC protocol on prescribing of mupirocin nasal ointment for decolonization before and after protocol implementation. Methods A retrospective review of mupirocin inpatient prescribing and outpatient clinic requests from March 2006 through February 2007 (1 year before ASC implementation) and from March 2007 through February 2008 (1 year after ASC implementation) was conducted. Cultures for MRSA after decolonization were evaluated. Results During the 24 months reviewed, 38 inpatients received mupirocin (18 before and 20 after ASC). Only 14 patients (37%) had a follow-up nasal swab (5 before and 9 after ASC). Of these patients, 5 (36%) had a positive nasal swab after the initial decolonization attempt. Ten patients (26%) had at least 1 clinical culture positive for MRSA after the initial decolonization (7 before and 3 after ASC). Outpatient requests for mupirocin increased 2.5-fold after ASC implementation. Sixty percent of the requests were not appropriate. Conclusion After implementation of the ASC protocol, there was no change in mupirocin prescribing for decolonization in the inpatient setting. However, outpatient requests—most of which were not indicated—increased. Success of decolonization cannot be assessed because follow-up nasal screening was not universally performed.
Antithrombin (Recombinant)
Authors: Cada Dennis J. , Levien Terri L. , Baker Danial E. 
Published: February 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 September 2009 monograph topics are dronedarone, prasugrel, ferumoxytol injection, canakinumab injection, and ibuprofen injection. The DUE is on dronedarone.
Increased Clinical Failures When Treating Acute Otitis Media with Macrolides: A Meta-Analysis
Authors: Courter Joshua D , Baker William L , Nowak Katherine S , Smogowicz Lori A , Desjardins Lindsey L , Coleman Craig I , Girotto Jennifer E 
Published: February 2010

Background: Macrolide antibiotics are often used to treat children with acute otitis media (AOM); however, the 2004 American Academy of Pediatrics (AAP) and American Academy of Family Physicians guidelines recommend against their use in patients without history of a type I allergic reaction to penicillins. Objective: To evaluate via meta-analysis the comparative efficacy of amoxicillin or amoxicillin/clavulanate to that of macrolide antibiotics in the treatment of children with AOM. Methods: A systematic literature search of MEDLINE, EMBASE, and International Pharmaceutical Abstracts was conducted from the earliest available date through September 2008. We used the following MeSH and key words: amoxicillin, amoxlcillin/clavulanate, Augmentin, azithromycin, ceftriaxone, clarithromycin, macrolides, AND media, otitis media, and effusion. Included studies were randomized, blinded, and controlled trials evaluating guideline-recommended antibiotics (amoxicillin or amoxicillin/clavulanate) compared to macrolide antibiotics (azithromycin or clarithromycin) in AOM in children. The primary outcome assessed was clinical failure measured between days 10 and 16 after starting antibiotic therapy. Results are reported as relative risks (RRs) with 95% confidence intervals and were calculated using a random-effects model. Results: A total of 10 trials (N = 2766) evaluating children 6 months–15 years old were included in the meta-analysis. Upon meta-analysis, the use of macrolide antibiotics was associated with an increased risk of clinical failure (RR 1.31 [95% CI 1.07 to 1.60]: p = 0.008) corresponding to a number needed to harm of 32. Upon safety analysis, rates of any adverse reaction (RR 0.74 [95% CI 0.60 to 0.90]: p = 0.003) and diarrhea (RR 0.41 [95% CI 0.32 to 0.52]: p < 0.0001) were significantly lower in the macrolide group. Conclusions: The meta-analysis suggests that patients treated with macrolides for AOM may be more likely to have clinical failures. As such, it supports the current AAP AOM recommendation that macrolides be reserved for patients who can not receive amoxicillin or amoxicillin/clavulanate.
Stability of Extemporaneously Prepared Rufinamide Oral Suspensions
Authors: Hutchinson David J , Liou Yayin , Best Robert , Zhao Fang 
Published: February 2010

Background: Rufinamide is an oral antiepileptic drug indicated for adjunctive therapy in treating generalized seizures associated with Lennox-Gastaut syndrome. Currently, rufinanide is available as 200-mg and 400-mg tablets. A liquid dosage form does not exist at the present time. Lack of a suspension formulation may present an administration problem for many children and adults who are unable to swallow tablets. The availability of a liquid dosage form will provide an easy and accurate way to measure and administer the medication. Objective: To determine the stability of both sugar-containing and sugar-free rufinamide suspensions over a 90-day period. Methods: A suspension of rufinamide 40 mg/mL was prepared by grinding twelve 400-mg tablets of rufinamide tablets in a glass mortar. Sixty milliliters of Ora-Plus and 60 mL of either Ora-Sweet or Ora-Sweet SF (sugar free) were mixed and added to the powder to make a final volume of 120 mL. Three identical samples of each formulation were prepared and placed in 60-mL amber plastic bottles and were stored at room temperature. A 1-mL sample was withdrawn from each of the 6 bottles with a micropipette immediately after preparation and at 7, 14, 28, 56, and 90 days. After further dilution to an expected concentration of 0.4 mg/mL, the samples were assayed using high-performance liquid chromatography. Stability was defined as the retention of at least 90% of the initial concentration. Results: At least 90% of the initial rufinamide concentration remained throughout the 90-day study period in both preparations. There were no detectable changes in color, odor, taste, and pH and no visible microbial growth. Conclusions: Extemporaneously compounded suspensions of rufinamide 40 mg/mL in a 1:1 mixture of Ora-Plus and Ora-Sweet or Ora-Sweet SF were stable for at least 90 days when stored in 59-mL amber polypropylene plastic bottles at room temperature.
Being Coloured and Looking Coloured
Authors: Allen Keith 
Published: February 2010

Intuitively, there is an intimate connection between being coloured and looking coloured. As Strawson memorably remarked, it is natural to assume that ‘colours are visibilia or they are nothing’ (1979, 109). But what exactly is the nature of this relationship?A traditionally popular view of the relationship between being coloured and looking coloured starts from the common place that the character of our perceptual experience changes as the conditions in which an object is perceived vary. For instance, our experience changes when we view an object under different illuminants, as when we move from artificial illumination indoors to natural daylight outside. It changes under one and the same illuminant, depending on whether the object is directly or indirectly illuminated. And it varies independently of this, as the background against which the object is perceived varies. Placing a lot of weight on the idea that objects look or appear different as the perceptual conditions vary, proponents of this approach suggest that we can understand what it is for something to be coloured in terms of what it is for something to look coloured in specific perceptual conditions.
Association of hyperhomocysteinemia with left ventricular dilatation and mass in human heart
Authors: Alter Peter , Rupp Heinz , Rominger Marga B. , Figiel Jens H. , Renz Harald , Klose Klaus J. , Maisch Bernhard 
Published: February 2010

Abstract

Background: Hyperhomocysteinemia is a risk factor for ischemic heart disease. Several other mechanisms apply also to dilative types of heart failure of various, non-ischemic etiologies. We hypothesized that hyperhomocysteinemia is associated with left ventricular (LV) dilatation and hypertrophy in dilative cardiomyopathy.

Methods: Homocysteine was measured in 66 individuals with suspected cardiomyopathy. Cardiac magnetic resonance imaging was used to assess LV volume, mass, and wall stress.

Results: Hyperhomocysteinemia (>12 μmol/L) was found in 45 patients (68%). LV mass was greater in these patients compared with individuals with normal homocysteine (83±27 vs. 67±19 g/m2; p<0.02). Homocysteine was increased in patients with increased brain natriuretic peptide ≥100 pg/mL (18.3±5.9 vs. 14.9±5.1 μmol/L; p=0.018). LV mass, LV end-diastolic and end-systolic volume (LVEDV, LVESV) were significantly increased in individuals in the upper quartile compared with the lower quartile (90±25 vs. 65±18 g/m2, p=0.021; 114±50 vs. 71±23 mL/m2, p=0.042; 76±51 vs. 36±22 mL/m2, p=0.045). LV dilatation (LVEDV≥90 mL/m2) was more common in hyperhomocysteinemia (>12 μmol/L, p=0.0166). Normalized LV mass was correlated with homocysteine (r=0.346, p=0.065). Homocysteine was not significantly correlated with LVEDV (r=0.229, p=0.065), LV end-diastolic wall stress (r=0.226, p=0.069) and LV ejection fraction.

Conclusions: Hyperhomocysteinemia appears to be, at least in part, involved in a disproportional LV dilatation, where the ensuing hypertrophy is not sufficient to compensate for the increased wall stress. A potential mechanism is the hyperhomocysteinemia associated increase in oxidative stress that favors muscle fiber slippage.
Clin Chem Lab Med 2010;48:555–60.
Endocrine treatment of transsexual persons: an Endocrine Society Clinical Practice Guideline: commentary from a European perspective
Authors: Meriggiola M C , Jannini E A , Lenzi A , Maggi M , Manieri C 
Published: February 2010

The treatment of transsexual subjects is a challenging task for the endocrinologist who, in collaboration with the mental health professional and the surgeon, is called upon to confirm the diagnosis and adjust hormonal treatment aimed at suppressing endogenous sex hormones and to develop hormone characteristics of the desired gender. These guidelines are structured to provide evidence-based suggestions or, where evidence is lacking, expert recommendations on diagnostic procedures and hormonal treatment in adolescent and adult transsexuals, including long-term care and eligibility for surgery. The multidisciplinary approach to treatment, the additional diagnostic role of hormone administration and the need to maintain hormone levels within the physiological range are key suggestions stressed in the guidelines which are particularly important for an endocrinologist unfamiliar with this field. The need for psychological assessment before surgery is not common in many countries and should be stressed further in the guidelines. Some important issues such as time and method of hormone withdrawal before surgery together with when and which hormones should be administered after sex reassignment surgery has been completed also remain unclear.These guidelines represent a pivotal document for endocrinologists setting a standard for the care of transsexuals and providing directions for future research.