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ISBT Code 128 implementation at a regional blood center.
BACKGROUND: Application specifications for ISBT 128 bar code symbology and the International Council for Commonality in Blood Bank Automation (ICCBBA) were created in 1994. By June 2000, the FDA considered ISBT 128 a standard for uniform labeling of blood and blood components. Our blood center initiated a change process for ISBT 128 implementation and "went live" in 2003. STUDY DESIGN AND METHODS: The intention to adopt ISBT 128 symbology with hospitals was actively communicated in October 2001. A Codabar-ISBT label cross-reference book was developed, FDA approval for the fullface label format in April 2002 was requested, and FDA approval was received in March 2003. In December 2002, donor identification labels and number sets were ordered, and an integration test plan was subsequently developed with departmental process flowcharts for each of the nine affected departments. Each step was tested, the labeling changes were approved in May 2003, training was completed in June 2003, and ISBT bar code symbology was implemented on July 1, 2003. A written survey was sent to hospital transfusion services in April 2004. RESULTS: Implementation went smoothly except for an unanticipated high rate of "no-reads" on some analyzers in the testing lab. The hospitals spent an average of 18 hours preparing for changes, 14 hours on validation, 4 hours on documentation and procedure development, and 8 hours on training. CONCLUSION: ISBT bar code symbology was successfully implemented. Hospital transfusion services made some adjustments and, overall, readily accepted the new bar code symbology.
Blood Banks↗
Characterization of Bouveret's syndrome: a comprehensive review of 128 cases.
AIM: The aim of the study was to characterize the clinical presentation, evaluation, and therapy of Bouveret's syndrome, by comprehensively reviewing all the identified previously reported cases, to facilitate early diagnosis and thereby to improve the prognosis. METHODS: Relevant articles were identified by MEDLINE computerized searches, by consultation with all available reference books, and by review of the first author's teaching files. A new case in which the diagnosis of Bouveret's syndrome was missed at esophagogastroduodenoscopy (EGD)--despite endoscopic findings of gastric outlet obstruction caused by a hard, nonfleshy, and convex pyloric mass--prompted this review. RESULTS: Review of 128 reported cases identified syndromic characteristics. Patients on average were 74.1 +/- 11.1 (SD) yr old. The female-to-male sex ratio was 1.86. Prominent symptoms were nausea and vomiting in 87%, abdominal pain in 71%, hematemesis in 15%, recent weight loss in 14%, and anorexia in 13% of patients. Prominent signs were abdominal tenderness in 44%, signs of dehydration in 31%, and abdominal distention in 26% of patients. Endoscopy revealed gastroduodenal obstruction in nearly all cases, but identified the obstructing stone in only 69%. Abdominal ultrasound or computerized tomography was diagnostic in about 60% of cases. CONCLUSIONS: The following endoscopic findings are suggestive of Bouveret's syndrome: a dilated stomach containing old digested food from gastrointestinal obstruction together with a hard and nonfleshy mass at the obstruction. These endoscopic findings, in the setting of the currently reported characteristic epidemiologic and clinical findings, should strongly suggest this syndrome. Abdominal ultrasound or computerized tomography is recommended to confirm and extend the endoscopic diagnosis.
Cholelithiasis↗
Escherichia coli and Salmonella 2000: the view from here.
Five years after the publication of the second edition of the reference book Escherichia coli and Salmonella: Cellular and Molecular Biology, and on the eve of launching a successor venture, the editors and colleagues examine where we stand in our quest for an understanding of these organisms. The main areas selected for this brief inquiry are genomics, evolution, molecular multifunctionality, functional backups, regulation of gene expression, cell biology, sensing of the environment, and ecology.
Biological Evolution↗
Systematic comparison of four sources of drug information regarding adjustment of dose for renal function.
OBJECTIVE: To compare advice on dosage adjustment for renal impairment provided by four commonly used secondary pharmacotherapeutic sources. DESIGN: Systematic comparison of the definitions of renal impairment, recommendations for dosage adjustment, and the evidence in support of these recommendations in four information sources. DATA SOURCES: British National Formulary, Martindale: the Complete Drug Reference, American Hospital Formulary System Drug Information, and Drug Prescribing in Renal Failure. REVIEW METHODS: Two reviewers independently extracted data on recommendations for dosage adjustment for impaired renal function of 100 drugs often used in our hospital. RESULTS: The four sources differed in their recommendations for adjustments of dosage and dosing interval. They vary in their definitions of renal impairment; some are qualitative and remain unclear. All sources provide only a general description; the methods on which the advice is based and references for original data are rarely presented. CONCLUSIONS: The remarkable variation in definitions and recommendations, along with scarce details of the methods used to reach this advice, makes the available sources of drug information ill suited for clinical use. The methods used to retrieve information and use data should be described and made available to the reader. Advice on drug prescription, dose and dosing interval, contraindications, and adverse effects should be evidence based.
Contraindications↗
Health information provided by retail health food outlets.
Alternative health practices have become increasingly popular in recent years. Many patients visit specific complementary practitioners, while others attempt to educate themselves, trusting advice from employees at local health food stores or the Internet. Thirty-two retail health food stores were surveyed on the nature of the information provided by their staff. A research assistant visited the stores and presented as the mother of a child in whom Crohn's disease had been diagnosed. Seventy-two per cent (23 of 32) of store employees offered advice, such as to take nutritional and herbal supplements. Of the 23 stores where recommendations were made, 15 (65%) based their recommendation on a source of information. Fourteen of the 15 stores using information sources used the same reference book. This had a significant impact on the recommendations; the use of nutritional supplements was favoured. In conclusion, retail health food stores are not as inconsistent as hypothesized, although there are many variances in the types of supplements recommended for the same chronic disease.
Adult↗
[Review of the interference between the most commonly prescribed drugs and clinical analyses at the Primary Health Care Centre of L'Hospitalet de Llobregat].
OBJECTIVE: To analyse the concordance of published information on probable drug interactions and the results of clinical analyses. DESIGN: Bibliographical review of the 50 most commonly prescribed drug products at the Primary Health Centre of L'Hospitalet de Llobregat, Barcelona, Spain, in 2002 and 2003. DATA SOURCE: Six bibliographical sources consisting of drug product catalogues and reference books. MEASUREMENTS: Interference with the 56 drug products studied. RESULTS: Most theoretical interference belonged to the therapeutic group of anti-inflammatory drugs. The drug products with most interference were hydrochlorothiazide (diuretic) and gliclazide (lipid lowering). The most frequent interference was in the increase of transaminases, thrombocytopaenia, leukopaenia, hyperglycaemia, and hyperuricaemia. Only in 12% of the points of interference analysed was the rate of concordance among the various bibliographical sources reviewed higher than 50%. The highest rate of concordance was found in the diuretics. CONCLUSIONS: Consultation of a single bibliographical source does not necessarily ensure the obtaining of reliable data on possible drug interference. This study demonstrates the need to standardize information on drug interference and to include the medication that the patient follows on the analysis application form.
Drug Interactions↗
Establishing a psychiatric library.
The amount of information in the psychiatric field has increased to such an extent that a specialized library is an essential part of the mental health facility. Guidelines are presented for establishing a psychiatric library, including staffing, budgeting, physical layout, and selection and handling of books, reference materials, journals and annuals, microfilm and microfiche, and audiovisuals. The expertise of the librarian is the single most important factor in determining the quality of the collection and the services provided, the author believes. Because of escalating costs, developing a cooperative library network of small, specialized mental health collections may be the most productive course for the future.
Humans↗
Parents' needs for knowledge concerning the medical diagnosis of their children.
It is reported that parents can handle their reactions of having a child with a chronic illness by seeking information and gaining knowledge about the diagnosis. It has been suggested that this is a way for parents to restore order in a chaotic existence. A complement to this perspective is to focus on what it means to be a parent and what is included in parenthood. The purpose of the present study was to increase our understanding of parents' need for knowledge. Interviews were conducted with parents (n = 44) who have experienced receiving a diagnosis of Turner Syndrome (TS) for their daughter, in order to explore the parents' motives and strategies for seeking information about the condition. Out of the 44 parents interviewed, 26 (21 mothers and 5 fathers) had sought information. It was found that the motives for seeking information were, to some extent, related to the parents' experiences of the consultation at the time of diagnosis. Twenty-three parents (21 mothers and 2 fathers) were dissatisfied with the information provided by the physician, while 21 (12 mothers and 9 fathers) were satisfied. Among the dissatisfied parents 16 (15 mothers and 1 father) sought information, and among the satisfied 10 parents (6 mothers and 4 fathers) sought information when they received the diagnosis for their daughter. The mothers described different strategies to gain information. They attended the library to borrow medical literature, looked up the syndrome in reference books, read articles in newspapers and asked questions of other mothers who had daughters with TS. However, it was found that the dissatisfied mothers used more and different strategies to find information compared with the fathers and the mothers who were satisfied. The motives of all the parents were to learn more about the condition. However, the dissatisfied mothers reported that they sought information because they found it important to control the actions of the professionals. The mothers that were satisfied with the information argued that they sought information in order to be able to explain the condition to others.
Adolescent↗
Medicinal plants and Alzheimer's disease: from ethnobotany to phytotherapy.
The use of complementary medicines, such as plant extracts, in dementia therapy varies according to the different cultural traditions. In orthodox Western medicine, contrasting with that in China and the Far East for example, pharmacological properties of traditional cognitive- or memory-enhancing plants have not been widely investigated in the context of current models of Alzheimer's disease. An exception is Gingko biloba in which the gingkolides have antioxidant, neuroprotective and cholinergic activities relevant to Alzheimer's disease mechanisms. The therapeutic efficacy of Ginkgo extracts in Alzheimer's disease in placebo controlled clinical trials is reportedly similar to currently prescribed drugs such as tacrine or donepezil and, importantly, undesirable side effects of Gingko are minimal. Old European reference books, such as those on medicinal herbs, document a variety of other plants such as Salvia officinalis (sage) and Melissa officinalis (balm) with memory-improving properties, and cholinergic activities have recently been identified in extracts of these plants. Precedents for modern discovery of clinically relevant pharmacological activity in plants with long-established medicinal use include, for example, the interaction of alkaloid opioids in Papaver somniferum (opium poppy) with endogenous opiate receptors in the brain. With recent major advances in understanding the neurobiology of Alzheimer's disease, and as yet limited efficacy of so-called rationally designed therapies, it may be timely to re-explore historical archives for new directions in drug development. This article considers not only the value of an integrative traditional and modern scientific approach to developing new treatments for dementia, but also in the understanding of disease mechanisms. Long before the current biologically-based hypothesis of cholinergic derangement in Alzheimer' s disease emerged, plants now known to contain cholinergic antagonists were recorded for their amnesia- and dementia-inducing properties.
Alzheimer Disease↗
The "schola medica salernitana": the forerunner of the modern university medical schools.
The schola medica salernitana is considered the oldest medical school of modern civilization. Salerno's long medical tradition began during the Greco-Roman period in a Greek colony named Elea, where Parmenides decided to found a medical school. The fame of the school became more and more important during the 10th century, and it was best known in the 11th century. In the middle of 12th century, the school was at its apogee, and Salerno provided a notable contribution to the formulation of a medical curriculum for medieval universities. The most famous work of the Salernitan School was the Regimen Sanitatis Saleritanum, a Latin poem of rational, dietetic, and hygienic precepts, many of them still valid today. The school also produced a physician's reference book, with advice on how to treat a patient, a sort of code of conduct to help the physician to respect the patient and his or her relatives. The first science-based surgery appeared on the scene of the discredited medieval practice in Salerno, thanks to Roger of Salerno and his fellows. He wrote a book on surgery, called Rogerina or Post Mundi Fabricam, in which surgery from head to toe is described, with surprising originality. The important contribution to the School of Salerno made by women as female practitioners is outlined, and among them, Trotula de Ruggiero was the most renowned. The period when the School of Salerno, universally recognized as the forerunner of the modern universities, became a government academy was when Frederick II reigned over the Kingdom of the Two Sicilies, as Emperor of the Holy Roman Empire.
Female↗
Lo Spedale di Poveri, the hospital for the poor in Milan: 15th to 20th century.
The construction of the Hospital for the Poor was begun in Milan in 1451 at the instigation of Francesco Sforza, Duke of Milan. In contrast to what had happened during the Dark Ages of the Medieval period, the new hospital was extraordinary both in construction and in medical organization. Wards for the patients were separated according to diseases, infective and noninfective, and according to sex. Each patient had his or her own bed and was fed adequately and kept warm. Patients were no longer treated by astrologers or monks but rather by doctors who had studied medicine at the University of Pavia. Each ward had its own doctor and surgeon, and from 1558 on, there was a doctor on duty in the hospital 24 hours a day. The hospital had its own pharmacy and drug reference book. The Hospital for the Poor, or Cà Granda (Big House), or the Ospedale Maggiore, as it was variously called from the 15th to the 19th centuries, became a training ground for anatomic and clinical studies. It was only in 1929 that a Faculty of Medicine was set up at Ospedale Maggiore.
Female↗
Update on ethambutol optic neuropathy.
Ethambutol optic neuropathy is a well-recognised adverse ocular event in patients who receive ethambutol for the treatment of mycobacterial infections. Much has been published on this condition; however, understanding of patient outcomes and the mechanism by which ethambutol optic neuropathy occurs, as well as data published in textbooks and reference books, tend to lag behind what is currently known. The purpose of this article is to update the clinician on what is currently accepted in regards to the clinical presentation of ethambutol optic neuropathy and what type of eye care should be provided to patients treated with this medication. In addition, new treatment recommendations are suggested to assist clinicians in complying with currently accepted standards of care.
Antitubercular Agents↗
[A review of screening tools to assess domestic violence against the elderly].
Data on elder abuse in Brazil are scarce. Systematic and thorough documentation can facilitate studies on magnitude, risk factors, and care of victims. This article reviews the existing screening tools on violence against elders in order to examine recent progress in the field, both in Brazil and abroad. A systematic review through MEDLINE, PsycINFO, LILACS, CANE, and OVID and reference books was performed using specific inclusion criteria. Studies on psychometric background and utilization of selected instruments were systematically examined, applying a set of quality assessment criteria. The Conflicts Tactics Scale was the only one of 17 identified scales that had been adapted to the Brazilian culture, although focusing on a younger age group. Some instruments with good psychometric characteristics were also found, namely the Caregiver Abuse Screen, Elder Abuse Assessment Tool, Hwalek Sengstok Abuse Screening Test, Indicators of Abuse Screen, QUALCARE scale, and Vulnerability to Abuse Screening Scale. However, there are still gaps in the process of design, validation, and adaptation, both in Brazil and abroad.
Aged↗
Approaches to education of pharmaceutical biotechnology in faculties of pharmacy.
Pharmaceutical biotechnology is developing rapidly both in academic institutions and in the biopharmaceutical industry. For this reason, FIP Special Interest Group of Pharmaceutical Biotechnology decided to develop a questionnaire concerning pharmaceutical biotechnology education. After preliminary studies were completed, questionnaires were sent to the leading scientists in academia and research directors or senior managers of various Pharmaceutical Biotechnology Companies in order to gather their views about how to create a satisfactory program. The objectives of this study were as follows: -To review all of the graduate and undergraduate courses which are presently available worldwide on pharmaceutical biotechnology in Faculties of Pharmacy. -To review all of the text books, references and scientific sources available worldwide in the area of pharmaceutical biotechnology. When replying to the questionnaires, the respondents were asked to consider the present status of pharmaceutical biotechnology education in academia and future learning needs in collaboration with the biotechnology industry. The data from various pharmacy faculties and biotechnology industry representatives from Asia, Europe and America were evaluated and the outcome of the survey showed that educational efforts in training qualified staff in the rapidly growing field of pharmaceutical biotechnology is promising. Part of the results of this questionnaire study have already been presented at the 57th International Congress of FIP Vancouver, Canada in 1997.
Biotechnology↗
On lies and health statistics: some Latin American examples.
New methods of demographic analysis are producing estimates of fertility and mortality which are sometimes at great variance with "official" figures generated by the statistics organizations of the different countries and which are reproduced in international reference books. This discrepancy is greatest with regard to infant mortality. Using Latin American examples, the magnitude of this discrepancy is explored, biases in estimating causes of mortality are identified, and a consideration is made of morbidity figures, which, as they are generated by health care systems with very low coverages of population, tend to seriously underrepresent the prevalent levels of disease. A structural interpretaton is made of the Latin American situation, linking this crisis of health statistics with a more general crisis of the "developmentist" model under which these systems flourished, and with an upsurge in political repression in the Continent which will tend in future to increase the inaccuracy of "official" health statistics data. Finally, alternative health statistics procedures are proposed.
Child, Preschool↗
Isolation of Candida dubliniensis from the oral cavity of an HIV-positive child in Brazil.
Candida dubliniensis is a newly-recognized Candida species and an important infectious pathogen, particularly for HIV-positive patients. >From oral smear samples from the radix linguae of 173 HIV-positive children, we obtained four yeast isolates which took a blue-green color on CHROMagar Candida plate at 37 degrees C for 48 hours from one HIV-positive 3-year-old boy in Brazil. The isolates were difficult to grow on potato dextrose agar plate at 42 degrees C, produced abundant chlamydospores on a cornmeal agar plate with Tween 80, and sprouted germ tubes in saline with horse serum, and the antigenic profile by CANDIDA CHECK test was useless. Carbohydrate assimilation tests by ID32C showed no reference code number in the reference book. The isolates were subjected to molecular biological assay of the DNA sequence of the large-subunit ribosomal DNA region (D1/D2) and randomly amplified polymorphic DNA (RAPD). The DNA sequence agreed with those of standard C. dubliniensis strains, and therefore, the isolates were identified as C. dubliniensis. RAPD band pattern analysis indicated that the clinical isolates might summarize one genotype. Although the child did not present oral lesions, the fungus might be latent for opportunistic infection.
Brazil↗
[History of prolonged-release formulations and the contribution of French pharmacy in this field].
The second part of the XXth century have seen the creation of new systems of administration for drugs, including delayed formulation systems or prolonged-release formulations (PRF). It is first within the industry, and mainly in the USA, that such new formulations were developed, with the purpose to increase the duration of action for pharmaceutical active principles. Several approaches were proposed and developed, jointly with more and more sophisticated evaluation techniques. In France, PRF market increased progressively during the 1980's; it then decreased because of more severe restrictions by health authorities for new drug approvals. In French specialty reference book (Vidal) included 518 PRF in the year 2000, from which 121 were tablets and 118 were hard gelatine capsules.
Delayed-Action Preparations↗