Pediatric Hematology/Oncology Outpatient Care: the Effect of a Standardized Collaborative Medication Reconciliation Process

Pediatric patients are at an increased risk for medication errors and can benefit from processes that facilitate and promote medication safety (Stone et al., 2010). Medication reconciliation (Med Rec) is a valuable tool in improving patients’ medication safety and reducing adverse drug events (The Joint Commission, 2015). The purpose of this evidence-based practice (EBP) project was to improve the accuracy of the Med Rec process in a Midwestern pediatric hematology/oncology outpatient clinic by developing, promoting, and evaluating a standardized, collaborative Med Rec process. The Stetler EBP model guided the implementation of the intervention, with the goal of integrating current evidence into current practice. Kotter’s Model of Change laid the theoretical foundation for successful implementation of a current practice change. This EBP project intervention included a patient and team member component. The patient component consisted of a verbal call reminder to bring medications to the visit, a patient handout emphasizing the importance of medication safety and reconciliation, and patient education regarding Med Rec process. The team member component included education regarding the importance of the Med Rec process and updates regarding Med Rec accuracy. The outcomes measured included the number, type, and severity of medication discrepancies and the number of voluntarily reported medication errors. Data were collected during Phase 1 (pre-intervention) and Phase 2 (post-intervention) by the physicians and the project leader (PL). These data were analyzed using chi-square tests. The intervention lead to a significant increase in the number of accurate Med Recs reported by the physicians between Phase 1 (n = 50, 70%) and Phase 2 (n = 65, 90.8%) (X2 = 8.167, df = 1, p = .004). An insignificant decrease in the number of accurate Med Recs was reported by the PL between Phase 1 (73.1%) and 2 (72.5%) (X2 = .003, df = 1, p = 0.959). Physicians reported more incorrectness errors in Phase 1 (73.3%) and Phase 2 (83.3%) than incompleteness errors (X2 = .481, df = 1, p = .786). PL reported more incompleteness errors in Phase 1 (71.4%) and Phase 2 than incorrectness errors (81.8%) (X2 = 1.670, df = 2, p = .434). The majority of Med Rec inaccuracies were classified as minor during Phase 1 and 2 by the physicians (X2 = .827, df = 2, p = .363) and the PL (X2 = 1.039, df = 1, p = .308). No inaccurate Med Rec was classified as severe by physicians or the PL. Finally, there were no voluntary medication errors were reported during the duration of the EBP project. Revision and replication of this EBP project would be helpful in further improving Med Rec accuracy in this setting

A Plan for Teaching Listening at Benjamin Franklin Junior High School, Springfield, Illinois

No abstract provided by author

A comparison of two central difference schemes for solving the Navier-Stokes equations

Five viscous transonic airfoil cases were computed by two significantly different computational fluid dynamics codes: An explicit finite-volume algorithm with multigrid, and an implicit finite-difference approximate-factorization method with Eigenvector diagonalization. Both methods are described in detail, and their performance on the test cases is compared. The codes utilized the same grids, turbulence model, and computer to provide the truest test of the algorithms. The two approaches produce very similar results, which, for attached flows, also agree well with experimental results; however, the explicit code is considerably faster

Mind the gap: Patterns of red blood cell product usage in South Africa, 2014 - 2019

Background. A key component of any successful healthcare system is the availability of sufficient, safe blood products delivered in an equitable manner. South Africa (SA) has a two-tiered healthcare system with public and privately funded sectors. Blood utilisation data for both sectors are lacking. Evaluation of blood utilisation patterns in each healthcare sector will enable implementation of systems to bring about more equality.Objectives. To conduct a critical evaluation of red blood cell (RBC) product utilisation patterns at the South African National Blood Service (SANBS).Methods. Operationally collected data from RBC requests submitted to SANBS blood banks for the period 1 January 2014 - 31 March 2019 were used to determine temporal RBC product utilisation patterns by healthcare sector. Demographic patterns were determined, and per capita RBC utilisation trends calculated.Results. Of the 2 356 441 transfusion events, 65.9% occurred in the public and 34.1% in the private sector. Public sector patients were younger (median (interquartile range (IQR)) 33 (22 - 49) years) than in the private sector (median (IQR) 54 (37 - 68) years), and mainly female in both sectors (66.2% in the public sector and 53.4% in the private sector). Between 2014 and 2018, per capita RBC utilisation decreased from 11.9 to 11.0/1 000 population in the public sector, but increased from 34.8 to 38.2/1 000 population in the private sector.Conclusions. We confirmed distinctly different RBC utilisation patterns between the healthcare sectors in SA. Possible drivers for these differences may be healthcare access, differing patient populations and prescriber habits. Better understanding of these drivers may help inform equitable public health policy

6'-Methoxy Raloxifene-analog enhances mouse bone properties with reduced estrogen receptor binding

Raloxifene (RAL) is an FDA-approved drug used to treat osteoporosis in postmenopausal women. RAL suppresses bone loss primarily through its role as a selective estrogen receptor modulator (SERM). This hormonal estrogen therapy promotes unintended side effects, such as hot flashes and increased thrombosis risk, and prevents the drug from being used in some patient populations at-risk for fracture, including children with bone disorders. It has recently been demonstrated that RAL can have significant positive effects on overall bone mechanical properties by binding to collagen and increasing bone tissue hydration in a cell-independent manner. A Raloxifene-Analog (RAL-A) was synthesized by replacing the 6-hydroxyl substituent with 6-methoxy in effort to reduce the compound's binding affinity for estrogen receptors (ER) while maintaining its collagen-binding ability. It was hypothesized that RAL-A would improve the mechanical integrity of bone in a manner similar to RAL, but with reduced estrogen receptor binding. Molecular assessment showed that while RAL-A did reduce ER binding, downstream ER signaling was not completely abolished. In-vitro, RAL-A performed similarly to RAL and had an identical concentration threshold on osteocyte cell proliferation, differentiation, and function. To assess treatment effect in-vivo, wildtype (WT) and heterozygous (OIM+/-) female mice from the Osteogenesis Imperfecta (OI) murine model were treated with either RAL or RAL-A from 8 weeks to 16 weeks of age. There was an untreated control group for each genotype as well. Bone microarchitecture was assessed using microCT, and mechanical behavior was assessed using 3-point bending. Results indicate that both compounds produced analogous gains in tibial trabecular and cortical microarchitecture. While WT mechanical properties were not drastically altered with either treatment, OIM+/- mechanical properties were significantly enhanced, most notably, in post-yield properties including bone toughness. This proof-of-concept study shows promising results and warrants the exploration of additional analog iterations to further reduce ER binding and improve fracture resistance

Evaluation of the microbial growth response to inorganic nanoparticles

In order to enhance the utilization of inorganic nanoparticles in biological systems, it is important to develop a fundamental understanding of the influence they have on cellular health and function. Experiments were conducted to test silica, silica/iron oxide, and gold nanoparticles for their effects on the growth and activity of Escherichia coli (E. coli). Transmission electron microscopy (TEM) and dynamic light scattering (DLS) were used to characterize the morphology and quantify size distribution of the nanoparticles, respectively. TEM was also used to verify the interactions between composite iron oxide nanoparticles and E. coli. The results from DLS indicated that the inorganic nanoparticles formed small aggregates in the growth media. Growth studies measured the influence of the nanoparticles on cell proliferation at various concentrations, showing that the growth of E. coli in media containing the nanoparticles indicated no overt signs of toxicity

Mass Spectrometry in the Home and Garden

Identification of active components in a variety of chemical products used directly by consumers is described at both trace and bulk levels using mass spectrometry. The combination of external ambient ionization with a portable mass spectrometer capable of tandem mass spectrometry provides high chemical specificity and sensitivity as well as allowing on-site monitoring. These experiments were done using a custom-built portable ion trap mass spectrometer in combination with the ambient ionization methods of paper spray, leaf spray, and low temperature plasma ionization. Bactericides, garden chemicals, air fresheners, and other products were examined. Herbicide applied to suburban lawns was detected in situ on single leaves 5 d after application

Climate and nitrogen controls on the geography and timescales of terrestrial biogeochemical cycling

We used the terrestrial ecosystem model “Century” to evaluate the relative roles of water and nitrogen limitation of net primary productivity, spatially and in response to climate variability. Within ecology, there has been considerable confusion and controversy over the large-scale significance of limitation of net primary production (NPP) by nutrients versus biophysical quantities (e.g., heat, water, and sunlight) with considerable evidence supporting both views. The Century model, run to a quasi-steady state condition, predicts “equilibration” of water with nutrient limitation, because carbon fixation and nitrogen fluxes (inputs and losses) are controlled by water fluxes, and the capture of nitrogen into organic matter is governed by carbon fixation. Patterns in the coupled water, nitrogen, and carbon cycles are modified substantially by ecosystem type or species-specific controls over resource use efficiency (water and nitrogen used per unit NPP), detrital chemistry, and soil water holding capacity. We also examined the coupling between water and nutrients during several temperature perturbation experiments. Model experiments forced by satellite-observed temperatures suggest that climate anomalies can result in significant changes to terrestrial carbon dynamics. The cooling associated with the Mount Pinatubo eruption aerosol injection may have transiently increased terrestrial carbon storage. However, because processes in the water, carbon, and nitrogen cycles have different response times, model behavior during the return to steady state following perturbation was complex and extended for decades after 1- to 5-year perturbations. Thus consequences of climate anomalies are influenced by the climatic conditions of the preceding years, and climate-carbon correlations may not be simple to interpret