Pharmacy intervention at an intensive care rehabilitation clinic

Introduction: During an intensive care stay, patients often have their chronic medications withheld for a variety of reasons and new drugs commenced [1]. As patients are often under the care of a number of different medical teams during their admission there is potential for these changes to be inadvertently continued [2]. Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) is a five week rehabilitation programme for patients and their caregivers after ICU (Intensive Care Unit) discharge at Glasgow Royal Infirmary. Within this programme a medication review by the critical care pharmacist provided an opportunity to identify and resolve any pharmaceutical care issues and also an opportunity to educate patients and their caregivers about changes to their medication. Methods: During the medication review we identified ongoing pharmaceutical care issues which were communicated to the patient’s primary care physician (GP) by letter or a telephone call. The patients were also encouraged to discuss any issues raised with their GP. The significance of the interventions was classified from those not likely to be of clinical benefit to the patient, to those which prevented serious therapeutic failure. Results: Data was collected from 47 of the 48 patients who attended the clinic (median age was 52 (IQR, 44-57) median ICU LOS was 15 (IQR 9-25), median APACHE II was 23 (IQR 18-27) and 32 of the patients were men (67%). The pharmacist made 69 recommendations; including 20 relating to drugs which had been withheld and not restarted, dose adjustments were suggested on 13 occasions and new drug recommendations were made for 10 patients. Duration of treatment for new medications started during hospital admission was clarified on 12 occasions. Lastly adverse drug effects were reported on 4 occasions and the incorrect drug was prescribed on 2 occasions. Of the interventions made 58% were considered to be of moderate to high impact. Conclusions: The pharmacist identified pharmaceutical care issues with 18.6% of the prescribed medications. Just over half of the patients reported that they were not made aware of any alterations to their prescribed medication on discharge. Therefore a pharmacy intervention is an essential part of an intensive care rehabilitation programme to address any medication related problems, provide education and to ensure patients gain optimal benefit from their medication

Bivariate stochastic modeling of functional response with natural mortality

A correction due to Abbott (1925) is the standard method of dealing with control mortality in insect bioassay to estimate the mortality of an insect conditional on control mortality not having occurred. In this article a bivariate stochastic process for overall mortality is developed in which natural mortality and predation are jointly modeled to take account of the competing-risks associated with prey loss. The total mortality estimate from this model is essentially identical with that from more classical modeling. However, when predation loss is estimated in the absence of control mortality the results are somewhat different, with the estimate from the bivariate model being lower than that from using Abbott’s formula in conjunction with the classical model. It is argued that overdispersion in observed mortality data corresponds to correlated outcomes (death or survival) for the prey initially present, while Abbott’s correction relies implicitly on independence

Colorectal neoplasm detection using virtual colonoscopy: A feasibility study

Abstract Background-Virtual colonoscopy is a potentially powerful tool for non-invasive colorectal evaluation. In vitro studies have established its accuracy in simulated polyp detection but little data exist regarding its use in clinical practice. Aims-To evaluate the ability of virtual colonoscopy to detect colorectal cancers and polyps in patients with endoscopically proven colorectal neoplasms and to correlate the findings of virtual colonoscopy with those of conventional colonoscopy, surgery, and histopathology. Patients-Thirty eight patients with endoscopic findings suggestive of colorectal carcinoma. Methods-Virtual colonoscopy was performed using thin section helical computed tomography (CT) of the abdomen and pelvis after rectal insuZation of room air. Commercially available software was used to generate endoscopic "fly through" examinations of the colon from the CT data. Results were correlated with the findings of conventional colonoscopy and with the surgical and histopathological outcome in each case. Results-Thirty eight pathologically proven colorectal cancers and 23 adenomatous polyps were present. On virtual colonoscopy, all cancers and all polyps measuring greater than 6 mm in size were identified; there were two false positive reports of polyps. On conventional colonoscopy, there was one false positive report of a malignant sigmoid stricture; four subcentimetre polyps were overlooked. Virtual colonoscopy enabled visualisation of the entire colon in 35 patients; conventional colonoscopy was incomplete in 14 patients. Virtual colonoscopy correctly localised all 38 cancers, compared with 32 using conventional colonoscopy. Conclusion-Virtual colonoscopy is a feasible method for evaluating the colon; it may have role in diagnosis of colorectal cancer and polyps. (Gut 1998;43:806-811

CT colonography reporting and data system: A consensus proposal

We have proposed a practical reporting scheme that includes recommendations for the follow-up of colonic polyps that are based on currently available published assessments of the clinical importance and expected growth potential of these lesions. © RSNA, 2005

Correction to. Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting

Objectives: To update the 2012 ESGAR consensus guidelines on the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer. Methods Fourteen abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) participated in a consensus meeting, organised according to an adaptation of the RAND-UCLA Appropriateness Method. Two independent (non-voting) Chairs facilitated the meeting. 246 items were scored (comprising 229 items from the previous 2012 consensus and 17 additional items) and classified as ‘appropriate’ or ‘inappropriate’ (defined by ≥ 80 % consensus) or uncertain (defined by < 80 % consensus). Results: Consensus was reached for 226 (92 %) of items. From these recommendations regarding hardware, patient preparation, imaging sequences and acquisition, criteria for MR imaging evaluation and reporting structure were constructed. The main additions to the 2012 consensus include recommendations regarding use of diffusion-weighted imaging, criteria for nodal staging and a recommended structured report template. Conclusions: These updated expert consensus recommendations should be used as clinical guidelines for primary staging and restaging of rectal cancer using MRI

Heart failure specialist nurse-led day case ambulatory management with intravenous diuretics reduces hospitalisations for acute decompensated heart failure irrespective of ejection fraction

Conocer las ventajas de la cirugía ambulatoria con anestesia local de hernia de pared abdominal en el Hospital Carlos Lanfranco la Hoz 2012-2015. El estudio fue de tipo descriptivo, analítico y retrospectivo. Paciente portador de hernia de la pared abdominal que cumple los criterios de inclusión y que recibieron las charlas preoperatorias del Hospital Carlos Lanfranco La Hoz. Se confeccionó una ficha de recolección de datos con base en el registro de historia clínica. El total fue 354 pacientes de los cuales se manejaron en forma de cirugía ambulatoria en 340 (96%) y mayor de 24 horas 14 (4%), con una mortalidad de 0 y morbilidad de 2,8%. Se aprecia una ligera predominancia en varones 50,56%. Predominio de adultos 45,2%. De 354 pacientes, 135 (38%) fueron intervenidos bajo anestesia local pura, 22 (6%) se utilizó anestesia local más analgesia ev. y 32 (9%) con anestesia local y sedación, un total de 189 (53%) de pacientes operados con anestesia local, adultos en 58,7%, no presentando complicaciones, y manejo ambulatorio al 100%. Si sumamos a las hernias inguino escrotales, las bilaterales, inguinal + umbilical e incisional sería la hernia inguinal la más frecuente 163(46%). Con anestesia local predominaron por igual las hernias umbilical e inguinal (83 cada una). El total de complicaciones fueron ocho (2,25%): tres hematomas (37%), inguinodinia tres casos (38%), fiebre postoperatoria uno (12%) y un caso de orquitis (13%), no se apreciaron seromas ni infección del sitio operatorio. Se concluye que es un método seguro, económico y de calidad para pacientes electivos y seleccionados. La morbilidad es baja. La anestesia local para hernia de pared abdominal es una técnica depurada, segura e inocua que permite una pronta recuperación

MRI characterization of 124 CT-indeterminate focal hepatic lesions: evaluation of clinical utility

Objective. To evaluate the diagnostic yield of MRI performed for characterization of focal hepatic lesions that are interpreted as indeterminate on CT. Patients and methods. In a retrospective investigation, 124 indeterminate focal hepatic lesions in 96 patients were identified on CT examinations over 5 years from 1997 to 2001. All patients had MRI performed for the liver within 6 weeks of their CT examination. CT and MR images were reviewed independently by two separate groups of two radiologists. The value of MRI in characterizing these lesions was assessed. Diagnoses were confirmed based on histology, characteristic imaging features, and clinical follow-up . Results. MRI definitely characterized 73 lesions (58%) that were indeterminate on CT. MRI was accurate in 72/73 of these lesions. MRI could not definitely characterize 51 lesions (42%). Ten lesions were not visualized on MRI, and follow-up imaging confirmed that no lesion was present in eight of these cases (pseudolesions). Conclusion. MRI is valuable for the characterization of indeterminate focal hepatic lesions detected on CT.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75168/1/13651820701216950.pd

Excavation of an early 17th-century glassmaking site at Glasshouse, Shinrone, Co. Offaly, Ireland

An archaeological research excavation was conducted in the area immediately surrounding an upstanding glassmaking furnace near Shinrone, Co. Offaly, Ireland. It dates to the early to mid 17th century and was built and operated by French Huguenots, probably de Hennezells (de Hennezel/Henzeys/Hensie) who had settled in this region as part of the Crown plantation of King’s County (now Co. Offaly). This furnace, which employed wood rather than coal as a fuel, is a very rare survival, with no other upstanding examples known in Ireland, Britain or the Lorraine region of France where the form probably originated