Comparative evaluation of three clinical decision support systems: prospective screening for medication errors in 100 medical inpatients

Purpose: Clinical decision support systems (CDSS) are promoted as powerful screening tools to improve pharmacotherapy. The aim of our study was to evaluate the potential contribution of CDSS to patient management in clinical practice. Methods: We prospectively analyzed the pharmacotherapy of 100 medical inpatients through the parallel use of three CDSS, namely, Pharmavista, DrugReax, and TheraOpt. After expert discussion that also considered all patient-specific clinical information, we selected apparently relevant alerts, issued suitable recommendations to physicians, and recorded subsequent prescription changes. Results: For 100 patients with a median of eight concomitant drugs, Pharmavista, DrugReax, and TheraOpt generated a total of 53, 362, and 328 interaction alerts, respectively. Among those we identified and forwarded 33 clinically relevant alerts to the attending physician, resulting in 19 prescription changes. Four adverse drug events were associated with interactions. The proportion of clinically relevant alerts among all alerts (positive predictive value) was 5.7, 8.0, and 7.6%, and the sensitivity to detect all 33 relevant alerts was 9.1, 87.9, and 75.8% for Pharmavista, DrugReax and TheraOpt, respectively. TheraOpt recommended 31 dose adjustments, of which we considered 11 to be relevant; three of these were followed by dose reductions. Conclusions: CDSS are valuable screening tools for medication errors, but only a small fraction of their alerts appear relevant in individual patients. In order to avoid overalerting CDSS should use patient-specific information and management-oriented classifications. Comprehensive information should be displayed on-demand, whereas a limited number of computer-triggered alerts that have management implications in the majority of affected patients should be based on locally customized and supported algorithm

Modelación numérica de deslizamientos de ladera en embalses mediante el método de partículas y elementos finitos (PFEM)

Se presentan resultados obtenidos mediante la aplicación del MétododePartículasyElementosFinitos (PFEM) en la simulación dedeslizamientosdeladeraenembalses. Es un fenómeno complejo, por la interacción entre el material deslizado, la masa de agua del embalse, yel conjunto formado por el vaso y la presa. PFEM es un esquema numérico original con el que se ha afrontado con éxito la resolución de problemas de interacción fluido-estructura. Combina un enfoque Lagrangiano con la resolución de las ecuaciones deelementosfinitosmediante la generación de una malla, que se actualiza en cada paso de tiempo. Se presentan resultados de casos de validación en los que se han reproducido ensayos en laboratorio existentes en la bibliografía técnica. Se muestran también otros cálculos más complejos, sobre la cartografía a escala real de un embalse, donde se aprecia el fenómeno de generación de la ola, su propagación por el embalse y la afección a la presa. Por último, se ha modelado el deslizamiento ocurrido en 1958 en la bahía de Lituya (Alaska), enel que la caída de 90 millones de toneladas de roca produjo una ola que alcanzó una sobreelevación máxima de 524 m en la ladera opuesta. Los resultados permiten afirmar que PFEM puede ser una herramienta útil enel análisis de riesgos frente a este tipo de fenómenos, ofreciendo una buena aproximación de las afecciones potenciale

Nanomechanical sensors: Measuring a response in blood

Nanomechanical cantilevers can determine the concentration of active drugs in human serum

Relativistic Structure of the Nucleon Self-Energy in Asymmetric Nuclei

The Dirac structure of the nucleon self-energy in asymmetric nuclear matter cannot reliably be deduced from the momentum dependence of the single-particle energies. It is demonstrated that such attempts yield an isospin dependence with even a wrong sign. Relativistic studies of finite nuclei have been based on such studies of asymmetric nuclear matter. The effects of these isospin components on the results for finite nuclei are investigated.Comment: 9 pages, Latex 4 figures include

Arznei- und Gewürzpflanzenanalytik im Hochdurchsatz – Technologie, Möglichkeiten und Anwendungen der numares NMR-Plattform

Um eine effiziente Analytik von Arznei- und Gewürzpflanzen zu gewährleisten und die hohe Variabilität an auftretenden Matrizes und Probentypen, ebenso wie die unterschiedlichsten analytischen Fragestellungen und Anforderungen bearbeiten zu können, ist eine Vielzahl komplementärer analytischer Methoden erforderlich.Die numares AG nutzt einen neuen, innovativen Ansatz, basierend auf der Kernspinresonanzspektroskopie (NMR), um Pflanzenzüchter und die verarbeitende Industrie bei der Analyse und Optimierung von Züchtungsprojekten, Prozessabläufen oder in der Qualitätskontrolle zu unterstützen. Nachfolgend werden anhand ausgewählter Beispiele die Technologie und deren Möglichkeiten und Anwendungsgebiete vorgestellt. Stichwörter: NMR, Hochdurchsatzanalytik, Elitenselektion, Metobolomic ProfilingMedicinal and Aromatic Plant Analysis in high-throughput – technology, possibilities and applications of the numares NMR-platformTo ensure an efficient analysis of medicinal and aromatic plants and to be able to handle the high variability occurring in matrices and sample types a variety of complementary analytical methods is required. The numares AG provides a new and innovative approach based on nuclear magnetic resonance (NMR) spectroscopy to assist plant breeders and industry in the analysis and optimization of breeding projects, process flows and in quality control. The technology, its potential and applications are presented below based on selected examples. Keywords: NMR, high-throughput screening, elite selection, metobolomic profilin

Macrophage cholesterol efflux correlates with lipoprotein subclass distribution and risk of obstructive coronary artery disease in patients undergoing coronary angiography

<p>Abstract</p> <p>Background</p> <p>Studies in patients with low HDL have suggested that impaired cellular cholesterol efflux is a heritable phenotype increasing atherosclerosis risk. Less is known about the association of macrophage cholesterol efflux with lipid profiles and CAD risk in normolipidemic subjects. We have therefore measured macrophage cholesterol efflux in142 normolipidemic subjects undergoing coronary angiography.</p> <p>Methods</p> <p>Monocytes isolated from blood samples of patients scheduled for cardiac catheterization were differentiated into macrophages over seven days. Isotopic cholesterol efflux to exogenously added apolipoprotein A-I and HDL2 was measured. Quantitative cholesterol efflux from macrophages was correlated with lipoprotein subclass distribution in plasma from the same individuals measured by NMR-spectroscopy of lipids and with the extent of coronary artery disease seen on coronary angiography.</p> <p>Results</p> <p>Macrophage cholesterol efflux was positively correlated with particle concentration of smaller HDL and LDL particles but not with total plasma concentrations of HDL or LDL-cholesterol. We observed an inverse relationship between macrophage cholesterol efflux and the concntration of larger and triglyceride rich particles (VLDL, chylomicrons). Subjects with significant stenosis on coronary angiography had lower cholesterol efflux from macrophages compared to individuals without significant stenosis (adjusted p = 0.02).</p> <p>Conclusion</p> <p>Macrophage cholesterol efflux is inversely correlated with lipoprotein particle size and risk of CAD.</p

CONCENTRATION OF FATTY ACID ETHYL ESTERS IN HAIR OF ALCOHOLICS: COMPARISON TO OTHER BIOLOGICAL STATE MARKERS AND SELF REPORTED-ETHANOL INTAKE

Aims: In a variety of clinical and forensic situations long term use of alcohol must be monitored. In this project we explore the utility of fatty acid ethyl esters (FAEE) in this regard. Additionally, we propose a cut-off value of FAEE to distinguish teetotallers/moderate/social drinkers from alcoholics or individuals drinking at harmful levels. Patients and methods: FAEE levels from 18 alcohol-dependent patients in detoxification were contrasted with those of 10 social drinkers and 10 teetotallers. FAEE in hair were determined, using headspace solid phase microextraction and gas chromatography mass spectrometry. CFAEE, as sum of the concentrations of four esters, was compared to a major FAEE, ethyl palmitate. PEth was measured in heparinized whole blood with a high pressure liquid chromatography (HPLC) method. Drinking validation criteria include self reports, phosphatidyl ethanol (PEth) in whole blood as well as the traditional markers of heavy drinking, gamma glutamyl transpeptidase (GGT), mean corpuscular volume (MCV) and carbohydrate deficient transferrin (CDT). Results: Receiver-operating characteristic (ROC) curve analysis for CFAEE, indicated a sensitivity of 100% and a specificity of 90% for a cut-off of 0.29 ng/mg. By using a cut-off of 0.4 ng/mg, CFAEE identified 94.4% correctly. CFAEE and ethyl palmitate were significantly associated (r = 0.945; P < 0.001) as were CFAEE and PEth (r = 0.527; P = 0.025). No significant correlation was found between CFAEE and total grams of ethanol consumed last month, blood-alcohol concentration at admission to the hospital, CDT, MCV, or GGT. Among the serum and blood markers, %CDT identified 47.1%, MCV 38.8% and GGT 72.2% of patients with chronic intake of higher amounts of ethanol correctly, whereas PEth achieved 100% accuracy. Conclusions: The data suggest that CFAEE is a potentially valuable marker of chronic intake of high quantities of ethanol. Furthermore, the results indicate that a reasonable and provisional FAEE cut-off to distinguish between social/moderate and heavy drinking/alcoholism in hair is 0.4 ng/m