Effects Of Implementing A Clinical Pharmacist Service In A Mixed Norwegian Icu

Цели: Неприемливо висок процент пациенти, приети в отделения по интензивно лечение (ОИЛ), развиват свързани с приема на лекарства проблеми (СЛП). СЛП могат да причинят увреждания и да увеличат разноските и продължителността на престоя. Доказано е, че въвеждането на клинично фармацевтично обслужване разкрива голям брой СЛП и ефективно допринася за разрешаването на същите в различни системи на здравеопазване. Обаче това не е проучено в перспектива в смесени третични норвежки ОИЛ.Методи: През 12-месечен период от м. октомври 2012 г. насетне един клиничен фармацевт се посвети на прегледи на лекарства 3 часа на ден (от понеделник до петък). СЛП бяха докладвани на срещата на ОИЛ и включваха консултация от страна на фармацевта за всеки отделен случай. Всички СЛП бяха категоризирани и клиничното въздействие бе документирано за по-нататъшен анализ. Бяха категоризирани свързаните с лекарства въпроси от страна на персонала и бе даден отговор на същите.Резултати: 363 от 549 приети в ОИЛ пациенти получиха рецензии за лекарствата. Бяха установени 641 СЛП у 194 от тези пациенти (средно по 1,8 СЛП на пациент, диапазон 0-25). Сред най-често установените СЛП бяха твърде високи дози, значими взаимодействия на лекарства и ненужни или неподходящи лекарства. 87% от консултациите, дадени от страна на фармацевта, бяха приети или взети предвид. Типичните въпроси от страна на медицинските сестри бяха свързани с приготвянето на лекарства, генерични еквиваленти и прием на лекарства. Въпросите от страна на лекарите най-често бяха свързани с дозировката на лекарствата, ефикасността и нежеланите ефекти.Изводи: Добавянето на специален клиничен фармацевт към екипа на ОИЛ подобрява качеството и безопасността на лекарствата в смесеното норвежко ОИЛ.Objectives: An unacceptably high proportion of patients admitted to intensive care units (ICUs) develop drug-related problems (DRPs). DRPs might cause harm and increase costs and length of stay. The implementation of a clinical pharmacist service has been shown to detect a high number of DRPs and contributes effectively to solving these across different healthcare systems. However, this has not been prospectively studied in a mixed tertiary Norwegian ICU.Methods: During a 12-month period from October 2012, a clinical pharmacist was dedicated to review medications 3 h daily (Monday to Friday). DRPs were reported at the ICU conference and included advice by the pharmacist for each case. All DRPs were categorized and the clinical impact was documented for later analysis. Drug-related questions from the staff were categorised and answered.Results: 363 of 549 patients admitted to the ICU received medication reviews. 641 DRPs were detected in 194 of these patients (mean 1.8 DRPs per patient, range 0-25). Too high a dose, significant drug interactions and unnecessary or inappropriate drugs were among the most frequently detected DRPs. 87% of advice given by the pharmacist was accepted or taken into consideration. Typical questions from the nursing staff were related to drug preparation, generic equivalents and drug administration. Questions from doctors were most frequently related to drug dosage, efficiency and adverse effects.Conclusions: The addition of a dedicated clinical pharmacist to the ICU team improves the quality and safety of medication in a mixed Norwegian ICU

Signature of Chaotic Diffusion in Band Spectra

We investigate the two-point correlations in the band spectra of spatially periodic systems that exhibit chaotic diffusion in the classical limit. By including level pairs pertaining to non-identical quasimomenta, we define form factors with the winding number as a spatial argument. For times smaller than the Heisenberg time, they are related to the full space-time dependence of the classical diffusion propagator. They approach constant asymptotes via a regime, reflecting quantal ballistic motion, where they decay by a factor proportional to the number of unit cells. We derive a universal scaling function for the long-time behaviour. Our results are substantiated by a numerical study of the kicked rotor on a torus and a quasi-one-dimensional billiard chain.Comment: 8 pages, REVTeX, 5 figures (eps

Inflammatory responses to induced infectious endometritis in mares resistant or susceptible to persistent endometritis

BACKGROUND: The objective of the study was to evaluate the gene expression of inflammatory cytokines (interleukin [IL]-1β, IL-6, IL-8, IL-10, tumor necrosis factor [TNF]-α, IL-1 receptor antagonist [ra] and serum amyloid A (SAA) in endometrial tissue and circulating leukocytes in response to uterine inoculation of 105 colony forming units (CFU) Escherichia coli in mares. Before inoculation, mares were classified as resistant or susceptible to persistent endometritis based on their uterine inflammatory response to infusion of 109 killed spermatozoa and histological assessment of the endometrial quality. Endometrial biopsies were obtained 3, 12, 24 and 72 hours (h) after bacterial inoculation and blood samples were obtained during the 7 day period post bacterial inoculation. Expression levels of cytokines and SAA were determined by quantitative real-time reverse transcriptase PCR (qRT-PCR). RESULTS: Compared to levels in a control biopsy (obtained in the subsequent estrous), resistant mares showed an up-regulation of IL-1β, IL-6, IL-8 and TNF-α at 3 h after E. coli inoculation, while susceptible mares showed increased gene expression of IL-6 and IL-1ra. Susceptible mares had a significant lower gene expression of TNF-α,IL-6 and increased expression of IL-1ra 3 h after E. coli inoculation compared to resistant mares. Susceptible mares showed a sustained and prolonged inflammatory response with increased gene expression levels of IL-1β, IL-8, IL-1ra and IL-1β:IL-1ra ratio throughout the entire study period (72 h), whereas levels in resistant mares returned to estrous control levels by 12 hours. Endometrial mRNA transcripts of IL-1β and IL-1ra were significantly higher in mares with heavy uterine bacterial growth compared to mares with no/mild growth.All blood parameters were unaffected by intrauterine E. coli infusion, except for a lower gene expression of IL-10 at 168 h and an increased expression of IL-1ra at 48 h observed in susceptible mares compared to resistant mares. CONCLUSIONS: The current investigation suggests that endometrial mRNA transcripts of pro-inflammatory cytokines in response to endometritis are finely regulated in resistant mares, with initial high expression levels followed by normalization within a short period of time. Susceptible mares had a prolonged expression of pro-inflammatory cytokines, supporting the hypothesis that an unbalanced endometrial gene expression of inflammatory cytokines might play an important role in the pathogenesis of persistent endometritis

A Phase-Field Model of Spiral Dendritic Growth

Domains of condensed-phase monolayers of chiral molecules exhibit a variety of interesting nonequilibrium structures when formed via pressurization. To model these domain patterns, we add a complex field describing the tilt degree of freedom to an (anisotropic) complex-phase-field solidification model. The resulting formalism allows for the inclusion of (in general, non-reflection symmetric) interactions between the tilt, the solid-liquid interface, and the bond orientation. Simulations demonstrate the ability of the model to exhibit spiral dendritic growth.Comment: text plus Four postscript figure file

Topography and instability of monolayers near domain boundaries

We theoretically study the topography of a biphasic surfactant monolayer in the vicinity of domain boundaries. The differing elastic properties of the two phases generally lead to a nonflat topography of ``mesas'', where domains of one phase are elevated with respect to the other phase. The mesas are steep but low, having heights of up to 10 nm. As the monolayer is laterally compressed, the mesas develop overhangs and eventually become unstable at a surface tension of about K(dc)^2 (dc being the difference in spontaneous curvature and K a bending modulus). In addition, the boundary is found to undergo a topography-induced rippling instability upon compression, if its line tension is smaller than about K(dc). The effect of diffuse boundaries on these features and the topographic behavior near a critical point are also examined. We discuss the relevance of our findings to several experimental observations related to surfactant monolayers: (i) small topographic features recently found near domain boundaries; (ii) folding behavior observed in mixed phospholipid monolayers and model lung surfactants; (iii) roughening of domain boundaries seen under lateral compression; (iv) the absence of biphasic structures in tensionless surfactant films.Comment: 17 pages, 9 figures, using RevTeX and epsf, submitted to Phys Rev

Top Grafting Longleaf x Slash Pine F1 Hybrids on Mature Longleaf and Slash Pine Interstocks

Top grafting is used to accelerate the breeding cycle of loblolly pine (Pinus taeda L). Scions, collected from seedlings as young as 1 year from seed, are grafted onto mature interstocks of the same or a related species. Male and female strobili production often begins 1 or 2 years after grafting, thus potentially decreasing the generation time by several years over conventional accelerated breeding methods. We are interested in applying top grafting to our breeding program involving interspecific hybrids, in particular longleaf x slash pine (Pinus palustris Mill. x Pinus elliottii Englem. var. elliottii) hybrids and their backcross generations. Towards this end, we grafted scions from 16 longleaf x slash pine F1 selections onto two longleaf and two slash pine interstock trees of different genotype. The F1 selections were 6 years old and none showed any signs of strobili development prior to, or during the experiment. A total of 100 grafts were made on to each interstock species. Scion survival after the second year was significantly higher on slash (72%) pine interstocks than on longleaf pine (18%). However there were no differences in male or female strobili production per living scion between the interstock species. Scions grew longer and produced more branches on slash pine interstocks than they did on longleaf. Given the relatively poor survival of the scions grafted onto longleaf interstocks and the reasonably good strobili production of scions grafted onto slash, we recommend using slash pine as the interstock species for top grafting longleaf x slash F1 hybrids.Papers and abstracts from the 27th Southern Forest Tree Improvement Conference held at Oklahoma State University in Stillwater, Oklahoma on June 24-27, 2003

Colorectal cancer-associated SNP rs17042479 is involved in the regulation of NAF1 promoter activity

A novel risk locus at 4q32.2, located between the Nuclear Assembly Factor 1 (NAF1) and Follistatin Like 5 (FSTL5) genes, was associated with increased risk of developing colorectal cancer (CRC), with SNP rs17042479 being the most associated. However, the link between CRC development and the risk locus at 4q32.2 is unknown. We investigated the promoter activity of NAF1 and FSTL5 and analyzed the risk locus at 4q32.2 as gene regulatory region. Our results showed that the activity of the FSTL5 promoter was low compared to the NAF1 promoter. Analyses of the NAF1 promoter in conjunction with the region containing the risk locus at 4q32.2 showed that the region functions as gene regulatory region with repressor activity on NAF1 promoter activity. The SNP rs17042479(G) increased the repressor effect of the region. CRC patients’ biopsies were genotyped for SNP rs17042479(A/G), and NAF1 expression profiles were examined. We found an association between SNP rs17042479(G), cancer stage and tumor location. Additionally, patients with SNP rs17042479(G) showed lower NAF1 expression in comparison to patients with SNP rs17042479(A) in tumor tissue and the NAF1 expression in tumor tissue was lower compared to healthy tissue. The results in the study imply that reduced NAF1 expression in the tumor contribute to a more aggressive phenotype. Furthermore, this study suggests that the SNP rs17042479(G) change the expression of NAF1 and thereby increases the risk of developing CRC

Mortality and causes of death in patients with sporadic inclusion body myositis: Survey study based on the clinical experience of specialists in Australia, Europe and the USA

Background: There is a paucity of data on mortality and causes of death (CoDs) in patients with sporadic inclusion body myositis (sIBM), a rare, progressive, degenerative, inflammatory myopathy that typically affects those aged over 50 years. Objective: Based on patient records and expertise of clinical specialists, this study used questionnaires to evaluate physicians’ views on clinical characteristics of sIBM that may impact on premature mortality and CoDs in these patients. Methods: Thirteen physicians from seven countries completed two questionnaires online between December 20, 2012 and January 15, 2013. Responses to the first questionnaire were collated and presented in the second questionnaire to seek elaboration and identify consensus. Results: All 13 physicians completed both questionnaires, providing responses based on 585 living and 149 deceased patients under their care. Patients were reported to have experienced dysphagia (60.2%) and injurious falls (44.3%) during their disease. Over half of physicians reported that a subset of their patients with sIBM had a shortened lifespan (8/13), and agreed that bulbar dysfunction/dysphagia/oropharyngeal involvement (12/13), early-onset disease (8/13), severe symptoms (8/13), and falls (7/13) impacted lifespan. Factors related to sIBM were reported as CoDs in 40% of deceased patients. Oropharyngeal muscle dysfunction was ranked as the leading feature of sIBM that could contribute to death. The risk of premature mortality was higher than the age-matched comparison population. Conclusions: In the absence of data from traditional sources, this study suggests that features of sIBM may contribute to premature mortality and may be used to inform future studies

The Shapes of Flux Domains in the Intermediate State of Type-I Superconductors

In the intermediate state of a thin type-I superconductor magnetic flux penetrates in a disordered set of highly branched and fingered macroscopic domains. To understand these shapes, we study in detail a recently proposed "current-loop" (CL) model that models the intermediate state as a collection of tense current ribbons flowing along the superconducting-normal interfaces and subject to the constraint of global flux conservation. The validity of this model is tested through a detailed reanalysis of Landau's original conformal mapping treatment of the laminar state, in which the superconductor-normal interfaces are flared within the slab, and of a closely-related straight-lamina model. A simplified dynamical model is described that elucidates the nature of possible shape instabilities of flux stripes and stripe arrays, and numerical studies of the highly nonlinear regime of those instabilities demonstrate patterns like those seen experimentally. Of particular interest is the buckling instability commonly seen in the intermediate state. The free-boundary approach further allows for a calculation of the elastic properties of the laminar state, which closely resembles that of smectic liquid crystals. We suggest several new experiments to explore of flux domain shape instabilities, including an Eckhaus instability induced by changing the out-of-plane magnetic field, and an analog of the Helfrich-Hurault instability of smectics induced by an in-plane field.Comment: 23 pages, 22 bitmapped postscript figures, RevTex 3.0, submitted to Phys. Rev. B. Higher resolution figures may be obtained by contacting the author