EVALUATION OF GUIDELINE DIRECTED MEDICAL THERAPY IN A PHARMACIST-LED HEART FAILURE CLINIC

Background: Guideline directed medical therapy (GDMT) for the treatment of heart failure with reduced ejection fraction (HFrEF) improves morbidity and mortality. According to the CHAMP-HF registry, only 15% of patients with HFrEF achieve target dosing. Published literature reports increased achievement of GDMT by 25-40% through a multidisciplinary approach. However, the pharmacists’ role on the impact of GDMT is not well described. The purpose of this study is to evaluate the impact that the CVD Ambulatory Care Pharmacy Clinic has on achievement of GDMT for patients with HFrEF. Methods: This is the interim analysis of an IRB approved retrospective cohort study. This study compares achievement of GDMT in HFrEF patients managed by the pharmacy clinic versus the control group. GDMT is defined as achievement of target dosing or maximum tolerated doses. Control group represents those not seen by CVD Pharmacy clinic. Inclusion criteria includes adult patients with EF ≤ 45%, hospitalization in the previous 12 months, followed by a cardiologist within the health system, and not on maximum tolerated doses of GDMT. The primary outcome is the number of patients on GDMT 12 months after the initial visit. Secondary outcomes include days from initial visit until GDMT, number of patients on moderate dosing of GDMT and change in EF after GDMT. Patients were enrolled from October 1, 2019 through September 30, 2020. Results: Achievement of GDMT at 12 months was 67.2% (39/58) in the intervention group compared to 16.2% (7/43) in the control (P \u3c0.001). Days to GDMT was a median of 95.5 [57-175.5] days and 143 [64-214] days for the intervention and control group respectively (P = 0.493). In the intervention group, 50% (29/58) of patients achieved moderate dosing at 12 months compared to 11.6% (5/43) in the control group (P\u3c0.001). Patients in the intervention group who had an echo after achieving GDMT had a median increase in EF of 12% [5-20] after GDMT achievement. For all patients who achieved GDMT, 32.6% (15/46) achieved target dosing of medications. Conclusion: The CVD Ambulatory Care Pharmacy Clinic was associated with higher rates of GDMT achievement compared to the control and a shorter time to GDMT achievement

The Relationship between Concurrent Substance Use Disorders and Eating Disorders with Personality Disorders

Objective: The current pilot study investigated whether patients with concurrent substance use disorders and eating disorders (SUD and ED) who experienced a reduction in SUD and ED symptoms following treatment for SUD and ED also experienced a reduction in personality disorder (PD) symptoms. Method: Twenty patients with SUD and ED and PD were assessed pre and post treatment using clinical interviews, self-report questionnaires, and a therapist questionnaire on DSM-IV-TR symptoms for PD. Results: Symptoms for the personality disorders were reduced following treatment. This reduction was correlated with a decrease in the number of symptoms of ED at post treatment. Discussion: Chronic concurrent SUD and ED may make it difficult to separate PD symptoms from co-occurring disorders. Many features attributed to PDs may be reduced when problematic substance use and disordered eating are addressed, a fact that may increase clinician and patients’optimism about therapeutic change

Crustal thickness variations along the Southeast Indian Ridge (100°–116°E) from 2-D body wave tomography

Axial morphology along the Southeast Indian Ridge (SEIR) systematically changes from an axial high to a deep rift valley at a nearly uniform intermediate spreading rate between 100°–116°E, west of the Australian-Antarctic Discordance (AAD). Basalt geochemistry has a consistent Indian–mid-ocean ridge basalt (MORB) type isotopic signature, so changes in axial topography are attributed to variations in both mantle temperature and melt supply. Wide-angle seismic refraction lines were shot to four ocean bottom hydrophones within SEIR segments P1, P2, S1, and T, where each segment is characterized by a different morphology. We constructed 2-D crustal velocity models by jointly inverting hand-picked P wave refraction (Pg) and Moho reflection (PmP) traveltime data using a top-down, minimum-structure methodology. The results show a 1.5 km eastward decrease in crustal thickness across the study area, with segment averages ranging from 6.1 km at P1 to 4.6 km at T. Melt generation models require a ~30°C decrease in mantle temperature toward the AAD to account for the crustal thickness trend. Significant changes in axial morphology accompany small-scale variations in crustal thickness, consistent with models of crustal accretion where ridge topography is determined by a balance between mantle temperature, melt supply, and cooling from hydrothermal circulation. Layer 3 thins by 3.0 km as layer 2 thickens by 1.4 km between segments P1 and T, reflecting the eastward decrease in melt supply and increase in melt lens depth. The trade-off in seismic layers may be explained by models relating the increase in overburden pressure on a deepening melt lens to the volume of magma erupted into the upper crust rather than cooling at depth to form new lower crustal material

Children and the Kingdom of God: A Comparison of the Gospel of Luke and the Gospel of Thomas

Both the Gospel of Luke and the noncanonical Gospel of Thomas depict Jesus teaching about children/infants entering the kingdom. My paper compares Luke 18:15-17 to logion 22 from the Gospel of Thomas. While the language in both of the texts appears to express the same ideas, my analysis demonstrates that the historical context of these passages reveal two very different meanings. I argue that the Gospel of Thomas is meant to show that people need to be transformed into a “single one,” whereas the Gospel of Luke is aimed at teaching people how to act so that they can be in communion with God and enter the kingdom

Pilot Study: Brief Educational Intervention for Mother-Baby Nursing Staff on Ask, Advise, and Refer for Tobacco Cessation

Purpose: Maternal smoking is the greatest modifiable risk factor for the prevention of tobacco-related adverse health outcomes to both the infant and the mother. While nurses working in maternal care units are primed to deliver appropriate patient-centered communication that focuses on the skills required by pregnant women and new mothers to successfully attain smoking cessation, communicating that message is complicated by the many competing demands that nurses experience at work. The purpose of this study was to provide brief educational training to nurses on how to efficiently assess, advise, and refer pregnant women and new mothers who smoke for smoking cessation services. Theoretical Model: The theoretical model used to develop the training program was derived from the national Prescription for Change Model developed and used by interdisciplinary health care professionals. Design: This pilot study used a one-group pre-test, post-test pre-experimental design. Setting: Two maternal care units at a Midwestern University Medical Center Hospital. Participants: A convenience sample of 17 maternal child nurses. Methods: A 10 minute educational training was provided during an in-service session for the nursing staff. The educational training included information on: a) Ask, advise, and refer, and b) use of a reminder card to be used by the nursing staff. A baseline survey was given with the initial training session, and a second survey was sent out eight weeks post-training. Results: Four nursing staff completed the baseline survey and three completed the second survey. The nurses who completed the surveys were female, with a mean age of 39 years, and had worked on the unit for an average length of 5 years. Nurses reported being highly confident in their abilities at delivering tobacco cessation services. Conclusions: Issues of nurse participation in educational research identified in this study are discussed. In the future, modifications will be made to the educational training program to enhance nurses’ participation in this type of practice-based research

DNA photocleavage by phenanthrenequinone diimine complexes of rhodium(III): shape-selective recognition and reaction

Rh(phen)_2phi^(3+) and Rh(phi)_2bpy^(3+) (phi = 9,10-phenanthrenequinone diimine, phen = 1, 10-phenanthroline, bpy = 2,2’-bipyridyl) bind double helical DNA avidly (K ≥ 10^7 M^(-1)) by intercalation and with photoactivation promote strand cleavage. Rh(phen)_2phi^(3+) and Rh(phi)_2bpy^(3+) unwind double helical DNA by 21° and 18°, respectively, per bound complex. The quantum yields for nucleic acid base release at 313 nm are 0.0012 for Rh(phen)_2phi^(3+) and 0.0003 for Rh(phi)_2bpy^(3+). While both complexes have similar photochemical properties, overall binding modes and affinities, their cleavage patterns, observed on ^(32)P-end-labeled DNA restriction fragments and oligonucleotide substrates, indicate substantially different recognition characteristics. Rh(phen)_2phi^(3+) binds DNA with some sequence selectivity, preferring 5’-pyrimidine-pyrimidine-purine-3’ sites and cleaving with 5’-asymmetry, while Rh(phi)_2bpy^(3+) binds in a predominantly sequence-neutral fashion. These differences in recognition characteristics may be understood based upon the different shapes of the complexes. Owing to steric interactions of the ancillary phenanthroline ligands, Rh(phen)_2phi^(3+) appears to bind preferentially to sites which are more open in the major groove; since no similar steric constraints arise with an ancillary phi ligand, Rh(phi)_2bpy^(3+) binds all sites with similar affinities. The shapes of these complexes also govern their chemistry of strand scission. Chemical modification studies and HPLC analyses of the DNA termini and monomeric products formed in the Rh(phi)^(3+) induced DNA cleavage reactions have been conducted to characterize the products formed upon photoreaction of the rhodium complexes with 5’-CTGGCATGCCAG-3’. For Rh(phen)_2phi^(3+), the primary products are oligomers containing 3’- and 5’-phosphate termini and nucleic acid bases (in stoichiometric proportion). For Rh(phi)_2bpy^(3+), these same products account for approximately 70% of the reaction, but in addition base propenoic acids and a terminus assigned as a 3’-phosphoglycaldehyde are obtained in a correlated amount (30% of reaction). The formation of base propenoic acids and 3’-phosphoglycaldehydes are found furthermore to depend upon oxygen concentration, while other products are oxygen-independent. The products obtained are consistent with photoreaction of Rh(phi)^(3+), intercalated in the major groove of DNA, via abstraction of a C3’-H atom of the deoxyribose. Subsequent addition of dioxygen to the C3’-H radical or solvation would lead to the degradation products obtained. The partitioning between the oxygen dependent and independent pathways of DNA strand scission is found to correlate best with how the shape of the complex limits access of dioxygen to the C-3’ position. While Rh(phi)_2bpy^(3+) was found to promote the oxygen-dependent pathway to an extent of approximately 30%, Rh(phen)_2phi^(3+), with ancillary phenanthrolines that overhang and shelter the C3’-position, appears to disfavor this pathway of DNA degradation. These studies underscore the importance of shape-selection in governing not only recognition but also reaction of molecules on the helix. Such an intimate relationship between recognition and reaction of molecules bound selectively to DNA requires consideration in understanding the reactions of DNA-binding proteins and small molecules

Evaluation of density variations to determine impact on sterile compounding

PURPOSE: To determine the density variation between (1) the measured density and manually calculated density, (2) density variation of different lots, and (3) density variation of different drug manufacturers in order to support institutions using gravimetric compounding methods. SUMMARY: Seventeen sterile injectable ingredient (drug) vials frequently used to make compounded sterile products (CSPs) were identified based on the ability to ensure that for each drug there were vials produced by 2 different manufacturers and 2 lots produced by the same manufacturer. Each drug\u27s density was measured using a density meter and by manual calculation using the institution\u27s density formula. Density differences were compared between the 2 different methods. Overall, the average drug density difference between the measured versus calculated density was determined to be 0.022. Further analysis revealed the average difference between the different lot numbers of the same manufacturers was 0.005 for the nonhazardous drugs and 0.0001 for the hazardous drugs. The average difference between the different manufacturers of the same drug was determined to be 0.008 for the nonhazardous drugs and 0.001 for hazardous drugs. CONCLUSION: No clinically meaningful difference exists when manually calculating a drug\u27s density compared to measuring a drug\u27s density using a density meter. In addition, there does not appear to be a sizeable density variation between the same drugs in separate lots or produced by different manufacturers