Pharmacist provided medicines reconciliation within 24 hours of admission and on discharge: A randomised controlled pilot study

Background: The UK government currently recommends that all patients receive medicines reconciliation (MR) from a member of the pharmacy team within 24 hours of admission and subsequent discharge. The cost-effectiveness of this intervention is unknown. A pilot study to inform the design of a future randomised controlled trial to determine effectiveness and cost-effectiveness of a pharmacist delivered service was undertaken. Method: Patients were recruited seven days a week from five adult medical wards in one hospital over a 9 month period and randomised using an automated system to intervention (MR within 24 hours of admission and at discharge) or usual care which may include MR (control). Recruitment and retention rates were determined. Length of stay(LOS), quality of life (EQ-5D-3L), unintentional discrepancies(UDs) and emergency re-admission(ER) within 3 months were tested as outcome measures. The feasibility of identifying and measuring intervention associated resources was determined. Result: 200 patients were randomised to either intervention or control. Groups were comparable at baseline.95(99%) of patients in the intervention received MR within 24 hours, whilst 62(60.8%) of control patients received MRat some point during admission. The intervention resolved 250 of the 255 UDs identifed at admission. Only 2 UDs were identifed in the intervention group at discharge compared with 268 in the control. The median LOS was 94 hours in the intervention arm and 118 hours in the control, with ER rates of 17.9% and 26.7%,respectively. Assuming 5% loss to follow up 1120 patients (560 in each arm) are required to detect a 6% reduction in 3 month ER rates. Conclusions: The results suggest that changes in outcome measures resulting from MR within 24 hours were in the appropriate direction and readmission within 3 months is the most appropriate primary outcome measure. A future study to determine cost-effectiveness of the intervention is feasible and warranted

Pharmacy led medicine reconciliation at hospital: a systematic review of effects and costs

Background: Transition of patients care between settings presents an increased opportunity for errors and preventable morbidity. A number of studies outlined that pharmacy-led medication reconciliation (MR) might facilitate safer information transfer and medication use. MR practice is not well standardised and often delivered in combination with other healthcare activities. The question regarding the effects and costs of pharmacy-led MR and the optimum MR practice is warranted of value.  Objectives: To review the evidence for the effects and costs/ cost-effectiveness of complete pharmacy-led MR in hospital settings.  Methods: A systematic review searching the following database was conducted up to the 13th December 2015; EMBASE & MEDLINE Ovid, CINAHL and the Cochrane library. Studies evaluating pharmacy-led MR performed fully from admission till discharges were included. Studies evaluated non-pharmacy-led MR at only one end of patient care or transfer were not included. Articles were screened and extracted independently by two investigators. Studies were divided into those in which: MR was the primary element of the intervention and labelled as “primarily MR” studies, or MR combined with non-MR care activities and labelled as “supplemented MR” studies. Quality assessment of studies was performed by independent reviewers using a pre-defined and validated tool.  Results: The literature search identified 4,065 citations, of which 13 implemented complete MR. The lack of evidence precluded addressing the effects and costs of MR.  Conclusions: The composite of optimum MR practice is not widely standardised and requires discussion among health professions and key organisations. Research focused on evaluating cost-effectiveness of pharmacy-led MR is lacking

Anatomizing Chemical and Biological Non-State Adversaries Identifying the Adversary, Final Report

PASCC ReportThis literature review forms part of the first phase of the Anatomizing Chemical and Biological Non-State Adversaries Project. As such, it serves three different functions. First, the review provides context for the overall study by introducing and specifying many of the basic concepts involved and can serve as a primer for those less familiar with the issues surrounding chemical and biological (CB) terrorism. Second, it synthesizes the existing literature on chemical and biological non-state adversaries and identifies the major areas of agreement and disagreement amongst scholars in the field. Third, it engages with the scholarship in an attempt to form the basis for inferring a set of preliminary qualitative indicators of the most likely future non-state perpetrators of CB violence, which is a core objective of Phase I of the project.This material is made possible in part by support from the Project on Advanced Systems and Concepts for Countering WMD (PASCC), Center on Contemporary Conflict, Naval Postgraduate School, under Grant No. N00244-12-1-0033. PASCC is supported by the Defense Threat Reduction Agency

Computational protein design enables a novel one-carbon assimilation pathway.

We describe a computationally designed enzyme, formolase (FLS), which catalyzes the carboligation of three one-carbon formaldehyde molecules into one three-carbon dihydroxyacetone molecule. The existence of FLS enables the design of a new carbon fixation pathway, the formolase pathway, consisting of a small number of thermodynamically favorable chemical transformations that convert formate into a three-carbon sugar in central metabolism. The formolase pathway is predicted to use carbon more efficiently and with less backward flux than any naturally occurring one-carbon assimilation pathway. When supplemented with enzymes carrying out the other steps in the pathway, FLS converts formate into dihydroxyacetone phosphate and other central metabolites in vitro. These results demonstrate how modern protein engineering and design tools can facilitate the construction of a completely new biosynthetic pathway

Computational protein design enables a novel one-carbon assimilation pathway.

We describe a computationally designed enzyme, formolase (FLS), which catalyzes the carboligation of three one-carbon formaldehyde molecules into one three-carbon dihydroxyacetone molecule. The existence of FLS enables the design of a new carbon fixation pathway, the formolase pathway, consisting of a small number of thermodynamically favorable chemical transformations that convert formate into a three-carbon sugar in central metabolism. The formolase pathway is predicted to use carbon more efficiently and with less backward flux than any naturally occurring one-carbon assimilation pathway. When supplemented with enzymes carrying out the other steps in the pathway, FLS converts formate into dihydroxyacetone phosphate and other central metabolites in vitro. These results demonstrate how modern protein engineering and design tools can facilitate the construction of a completely new biosynthetic pathway

Computational protein design enables a novel one-carbon assimilation pathway

We describe a computationally designed enzyme, formolase (FLS), which catalyzes the carboligation of three one-carbon formaldehyde molecules into one three-carbon dihydroxyacetone molecule. The existence of FLS enables the design of a new carbon fixation pathway, the formolase pathway, consisting of a small number of thermodynamically favorable chemical transformations that convert formate into a three-carbon sugar in central metabolism. The formolase pathway is predicted to use carbon more efficiently and with less backward flux than any naturally occurring one-carbon assimilation pathway. When supplemented with enzymes carrying out the other steps in the pathway, FLS converts formate into dihydroxyacetone phosphate and other central metabolites in vitro. These results demonstrate how modern protein engineering and design tools can facilitate the construction of a completely new biosynthetic pathway