Search

Strategies for introducing or strengthening cervical cancer prevention programs must focus on ensuring that appropriate, cost-effective services are available and that women who most need the services will, in fact, use them. This article summarizes the experiences of research projects in Bolivia, Peru, Kenya, South Africa, and Mexico. Factors that affect participation rates in cervical cancer prevention programs are categorized in three sections. The first section describes factors that arise from prevailing sociocultural norms that influence women's views on reproductive health, well being, and notions of illness. The second section discusses factors related to the clinical requirements and the type of service delivery system in which a woman is being asked to participate. The third section discusses factors related to quality of care. Examples of strategies that programs are using to encourage women's participation in cervical cancer prevention services are provided.

Abstract Background Malaria is a leading cause of mortality and morbidity in Mozambique, with nearly three-quarters of the country’s malaria-related deaths occurring in children younger than five years. A malaria vaccine is not yet available, but planning is underway for a possible introduction, as soon as one becomes available. In an effort to inform the planning process, this study explored sociocultural and health communications issues among individuals at the community level who are both responsible for decisions about vaccine use and who are likely to influence decisions about vaccine use. Methods Researchers conducted a qualitative study in two malaria-endemic districts in southern Mozambique. Using criterion-based sampling, they conducted 23 focus group discussions and 26 in-depth interviews. Implementation was guided by the engagement of community stakeholders. Results Community members recognize that malaria contributes to high death rates and affects the workforce, school attendance, and the economy. Vaccines are seen as a means to reduce the threat of childhood illnesses and to keep children and the rest of the community healthy. Perceived constraints to accessing vaccine services include long queues, staff shortages, and a lack of resources at health care facilities. Local leaders play a significant role in motivating caregivers to have their children vaccinated. Participants generally felt that a vaccine could help to prevent malaria, although some voiced concern that the focus was only on young children and not on older children, pregnant women, and the elderly. Probed on their understanding of vaccine efficacy, participants voiced various views, including the perception that while some vaccines did not fully prevent disease they still had important benefits. Overall, it would be essential for local leaders to be involved in the design of specific messages for a future malaria vaccine communications strategy, and for those messages to be translated into local languages. Conclusions Acceptance of routine childhood vaccines bodes well for a future malaria vaccine. Vaccinating children is a well-established routine that is viewed favourably in Mozambique. A communications strategy would need to build on existing immunization efforts and use trusted sources—including current government dissemination arrangements—to deliver health information.

Abstract Background Malaria is a leading cause of morbidity and mortality in children younger than 5 years in Kenya. Within the context of planning for a vaccine to be used alongside existing malaria control methods, this study explores sociocultural and health communications issues among individuals who are responsible for or influence decisions on childhood vaccination at the community level. Methods This qualitative study was conducted in two malaria-endemic regions of Kenya--South Coast and Busia. Participant selection was purposive and criterion based. A total of 20 focus group discussions, 22 in-depth interviews, and 18 exit interviews were conducted. Results Participants understand that malaria is a serious problem that no single tool can defeat. Communities would welcome a malaria vaccine, although they would have questions and concerns about the intervention. While support for local child immunization programs exists, limited understanding about vaccines and what they do is evident among younger and older people, particularly men. Even as health care providers are frustrated when parents do not have their children vaccinated, some parents have concerns about access to and the quality of vaccination services. Some women, including older mothers and those less economically privileged, see themselves as the focus of health workers' negative comments associated with either their parenting choices or their children's appearance. In general, parents and caregivers weigh several factors--such as personal opportunity costs, resource constraints, and perceived benefits--when deciding whether or not to have their children vaccinated, and the decision often is influenced by a network of people, including community leaders and health workers. Conclusions The study raises issues that should inform a communications strategy and guide policy decisions within Kenya on eventual malaria vaccine introduction. Unlike the current practice, where health education on child welfare and immunization focuses on women, the communications strategy should equally target men and women in ways that are appropriate for each gender. It should involve influential community members and provide needed information and reassurances about immunization. Efforts also should be made to address concerns about the quality of immunization services--including health workers' interpersonal communication skills.

Purpose: The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several board-certified nutrition support pharmacists aggregated a list of articles relevant to pharmacy nutrition support published in 2023. The list was compiled into a spreadsheet whereby the authors were asked to assess whether the article was considered important. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the article to be important for pharmacists practicing in nutrition support. Guideline and consensus papers, important to practice but not ranked, were also included. Results: A total of 133 articles were identified; 9 from the primary literature were voted by the group to be of high importance. Fourteen guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Drs. Dickerson and Bingham have no conflicts of interest. Dr. Canada is on the speaker’s bureau and consultant for Fresenius Kabi. Dr. Chan is a consultant for Baxter healthcare. Dr. Cober is a consultant for BBraun/CAPS, Baxter, Fresenius-Kabi, and Wolters-Kluwer and speaker for Fresenius-Kabi. Dr. Tucker is a consultant for Up to Date, Inc. Dr. Kumpf is a consultant for Fresenius Kabi, Baxter, and VectivBio., (© The Author(s) 2024.)

Background: Literature on optimal energy provision via parenteral nutrition (PN) is limited and the evidence quality is low. The purpose of this study is to determine if there is a difference in outcomes in adult critically ill patients when receiving lower vs higher calorie provision via PN early in intensive care unit (ICU) stay., Methods: Adult patients initiated on PN within the first 10 days of ICU stay from May 2014 to June 2021 were included in this retrospective study. The primary outcome was to determine the impact of lower (<20 kcal/kg/day) vs higher (>25 kcal/kg/day) calorie provision on all-cause, in-hospital mortality. Secondary outcomes were to determine the impact of calorie provision on hospital or ICU length of stay and incidence of complications., Results: This study included 133 patients: a lower calorie provision group (n = 77) and a higher calorie provision group (n = 56). There was a significant difference in all-cause, in-hospital mortality between the lower and the higher calorie provision groups (36.36% and 17.86%, respectively; P = 0.02). However, upon a multivariate analysis of death at discharge, the specific calorie provision group did not affect the probability of death at hospital discharge. The secondary outcomes were not significantly different between groups., Conclusion: When comparing lower calorie provision with higher calorie provision in adult critically ill patients receiving PN early within their ICU stay, there were no differences in outcomes after controlling for significant confounders. Future larger prospective studies should further evaluate optimal caloric provision via PN in this population., (© 2023 American Society for Parenteral and Enteral Nutrition.)

Objective: To assess the impact of student pharmacist state anxiety on vasopressor calculation accuracy in advanced cardiac life support (ACLS) simulations., Methods: Third-year professional students participated in 2 ACLS-related simulation laboratory sessions. In week 1, students completed 3 calculations at their workstation with no stressors. Students were then randomized into teams for a bedside simulation where they independently completed 3 additional calculations either with or without stressors. Team assignments were maintained for week 2 where all participants completed a high-fidelity ACLS simulation that included a team vasopressor calculation. At both encounters, calculation accuracy was assessed as well as pre- and post-state anxiety using the Spielberger State-Trait Anxiety Inventory (STAI) survey tool., Results: Students' (N = 145) trait anxiety aligned with normative data for similarly aged professional students. Post-simulation state anxiety in week 1 was found to be higher for those completing the activity with stressors than without (STAI score 44.7 vs 36.9) paired with lower bedside calculation accuracy, despite similar initial workstation calculation accuracy. In week 2, pre-simulation state anxiety score and calculation accuracy were not significantly different between the 2 groups. However, the state anxiety score significantly increased post-simulation for those exposed to stress in the previous week., Conclusion: Stress negatively impacted student pharmacist vasopressor calculation accuracy. However, the repeated exposure to a stressed simulation did not result in a significant difference in pre- or post-simulation state anxiety score or calculation accuracy when compared to a non-stressed control. Consideration should be made whether to include more "real-life" simulations in student pharmacist education., Competing Interests: Declaration of Competing Interest None declared., (Published by Elsevier Inc.)

Objective: To determine the prevalence of board certification among pharmacy practice faculty in the United States, motivators and barriers to certification, and association between board certification and professional achievements and accomplishments that may support career advancement., Methods: In phase I, the prevalence of board-certified pharmacy practice faculty in the United States was determined by cross-referencing lists of faculty and board-certified pharmacists. In phase II, faculty were stratified by rank and invited to participate in a survey regarding professional characteristics, motivators and barriers to board certification, and professional achievements and accomplishments that may support career advancement for pharmacy practice faculty., Results: The prevalence of board certification among the 3276 pharmacy practice faculty was 56%. The prevalence was the highest among assistant professors (61%). A total of 746 faculty completed the survey (33% response rate). Of those respondents, 73% reported being currently certified, 23% never certified, and 4% previously certified. Overall, to be recognized as an expert in the field was identified as the most commonly perceived reason faculty obtain board certification (44%). Currently and previously certified faculty ranked the desire to be recognized as an expert in the field as the most common reason they obtained board certification (61%). There was a positive correlation between board certification and certain professional accomplishments., Conclusion: The prevalence of board-certified pharmacy practice faculty has increased since 2011, but motivators and barriers for board certification remain similar. Board certification may support career advancement for pharmacy practice faculty., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Volodymyra Fedkiv reports financial support was provided by Board of Pharmacy Specialties. Angela L. Bingham reports a relationship with Board of Pharmacy Specialties that includes: board membership., (Copyright © 2023 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

Introduction: The performance of bystander cardiopulmonary resuscitation (CPR) improves survival among cardiac arrest victims. Near-peer teaching of Basic Life Support (BLS) may be an effective way to deliver resuscitation education. This article aims to assess the effectiveness of a student pharmacist-led American Heart Association (AHA) BLS course on high school students' knowledge and skill achievement. Methods: Student pharmacists were trained as AHA instructors and delivered BLS certification courses to high school students. Participants completed pre- and post-assessments adapted from the course learning objectives. Skills performance was evaluated using the AHA's standardized forms. Participants completed questions regarding their perceptions of the pharmacist's role in BLS and confidence in pursuing a career in healthcare. Results: There were 321 participants with the majority in 11th or 12th grade (86.6%) and attending public school (99.1%). After completing the training, the mean percentage of correct assessment responses increased from 41.2% to 89% (p <0.0001). All participants correctly performed BLS skills. Most participants strongly agreed or agreed that the course changed their perspective of the pharmacist's role during BLS (74.8%) and increased their confidence in their decision to pursue future careers in healthcare (61.7%). Conclusion: Student pharmacist-led BLS training, using near-peer delivery, improves high school students' knowledge and skill achievement. This strategy promotes high school students' positive perceptions regarding pharmacists and their role in BLS, as well as their confidence in pursuing careers in healthcare., (© Individual authors.)

Purpose: The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2022 considered important to their clinical practice. The citation list was compiled into a spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the article to be important. Guideline and consensus papers, important to practice but not ranked, were also included. Results: A total of 162 articles were identified; 8 from the primary literature were voted by the group to be of high importance. An additional 10 guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Dickerson is a speaker for Abbott Nutrition Health Institute and Baxter Healthcare Corporation. Dr. Bingham is a speaker for Abbott Nutrition Health Institute. Dr. Canada is a consultant for Fresenius Kabi. Dr. Chan has no potential or perceived conflicts of interest. Dr. Cober is a consultant for B Braun, Fresenius Kabi, Wolters Kluwer and a speaker for Baxter Healthcare Corporation. Dr. Cogle is a speaker and consultant for Fresenius Kabi. Dr. Tucker is a consultant for Up to Date, Inc. Dr. Kumpf is a consultant for Takeda Pharmaceuticals and Fresenius Kabi., (© The Author(s) 2023.)

Purpose: The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2021 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the paper to be important. Guideline and consensus papers from professional organizations, important to practice but not ranked, were also included. Results: A total of 211 articles were identified; 8 from the primary literature were voted by the group to be of high importance. An additional 18 guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice., Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Dickerson is a speaker and consultant for Baxter Healthcare and Abbott Nutrition. Dr. Cober is a consultant for BBraun/CAPS, Baxter Healthcare, Fresenius Kabi, and Lexi-Com. Dr. Cogle is a speaker and consultant for Fresenius Kabi. Dr. Tucker is a speaker for CAPS Pharmacy Services. Dr. Kumpf is a consultant for American Regent, Fresenius Kabi, and VectivBio., (© The Author(s) 2022.)

Background: This guideline updates recommendations from the 2016 American Society for Parenteral and Enteral Nutrition (ASPEN)/Society of Critical Care Medicine (SCCM) critical care nutrition guideline for five foundational questions central to critical care nutrition support., Methods: The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) process was used to develop and summarize evidence for clinical practice recommendations. Clinical outcomes were assessed for (1) higher vs lower energy dose, (2) higher vs lower protein dose, (3) exclusive isocaloric parenteral nutrition (PN) vs enteral nutrition (EN), (4) supplemental PN (SPN) plus EN vs EN alone, (5A) mixed-oil lipid injectable emulsions (ILEs) vs soybean oil, and (5B) fish oil (FO)-containing ILE vs non-FO ILE. To assess safety, weight-based energy intake and protein were plotted against hospital mortality., Results: Between January 1, 2001, and July 15, 2020, 2320 citations were identified and data were abstracted from 36 trials including 20,578 participants. Patients receiving FO had decreased pneumonia rates of uncertain clinical significance. Otherwise, there were no differences for any outcome in any question. Owing to a lack of certainty regarding harm, the energy prescription recommendation was decreased to 12-25 kcal/kg/day., Conclusion: No differences in clinical outcomes were identified among numerous nutrition interventions, including higher energy or protein intake, isocaloric PN or EN, SPN, or different ILEs. As more consistent critical care nutrition support data become available, more precise recommendations will be possible. In the meantime, clinical judgment and close monitoring are needed. This paper was approved by the ASPEN Board of Directors., (© 2021 American Society for Parenteral and Enteral Nutrition.)

Background Prevalence of sexually transmissible infections (STIs) has been associated with availability of alcohol. This paper investigates potential associations between prevalent cases of chlamydia in young people in Australia and the availability of alcohol within their local area, defined as postcode of residence. Methods Alcohol availability was determined at the postcode level using liquor licensing data, classified as total number of licences, number of 'take-away' licences and number of licenses by population. Participant data were drawn from a survey targeting Australians aged 16-29years in rural and regional Australia, capturing demographic details including postcode of residence, indicators of sexual behaviour including condom use and chlamydia test results. Mixed-effects logistic regression was used to examine potential associations between first, alcohol availability and chlamydia, and second, between condom use and chlamydia. Results We found little evidence of associations between alcohol availability and chlamydia in either unadjusted or adjusted models. After adjusting for alcohol availability, we observed significant associations between inconsistent condom use and chlamydia prevalence, whether alcohol availability was measured as total number (adjusted odds ratio (AOR) 2.20; 95% confidence interval (CI) 1.20, 3.70), number of take-away licenses (AOR 2.19; 95% CI1.30, 3.69) or licenses per 1000 population (AOR 2.19; 95% CI 1.30, 3.68). Conclusion Little evidence of association between alcohol availability and chlamydia at the postcode level was found. Further research is required to determine appropriate measures of 'local area' and how characteristics thereof may impact on sexual health.

Purpose: The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2020 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the paper to be important. Guideline and consensus papers from professional organizations, important to practice but not ranked, were also included. Results: A total of 169 articles were identified; 5 from the primary literature were voted by the group to be of high importance. An additional 17 guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2019 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the paper to be important. Guideline and consensus papers from professional organizations, important to practice but not ranked, were also included. Results: A total of 111 articles were identified; 6 from the primary literature were voted by the group to be of high importance. An additional 9 organizational guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Background and Purpose: Basic life support (BLS) and advanced cardiac life support (ACLS) skills performance, as well as simulated patient survival, were compared for student pharmacist teams with and without at least one member with American Heart Association (AHA) ACLS certification., Educational Activity and Setting: Doctor of pharmacy students in their third professional year completed a high-fidelity mannequin simulation. Within the previous year, 30 of 184 students (16%) completed ACLS certification. Rapid response teams (n = 31) of five to six members were formed through random student assignment. Two AHA instructors recorded and assessed performance using a checklist adapted from the AHA's standardized forms for BLS and ACLS assessment. Teams with and without ACLS certified members were compared for skills performance and simulated patient survival (i.e. correct performance of all BLS and ACLS skills)., Findings: Teams with ACLS certified members (n = 21) were superior to teams without certified members (n = 10) for correct performance of all observed BLS and ACLS skills, including pulse assessment and medication selection for cardiovascular support. For teams who had ACLS certified members, simulated patient survival was 86% higher. The study groups did not differ in their ability to calculate a correct vasopressor infusion rate if warranted., Summary: BLS and ACLS skills performance were improved by AHA ACLS certification. Additionally, simulated patient survival was improved for teams with students who had at least one ACLS certified member., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The European Society for Clinical Nutrition and Metabolism Guidelines for Parenteral Nutrition in Geriatric Patients state metabolic complications are more frequent in elderly patients. However, literature provides limited information about metabolic complications in older patients receiving parenteral nutrition (PN). Consequently, the purpose of this study was to compare the development of metabolic complications in older vs younger patients receiving PN., Methods: Patients receiving PN from May 1, 2014, to February 7, 2017, at Cooper University Hospital were included. Metabolic complications assessed included acid-base disturbances, hepatic complications, hypercapnia, hyperchloremia, hyperglycemia, hypernatremia, hypertriglyceridemia, hypochloremia, hypoglycemia, hypokalemia, hypophosphatemia, and refeeding syndrome., Results: 595 patients were included (older group [≥65 years]: n = 245, median age: 76 years; younger group [<65 years]: n = 350, median age: 53 years]. Certain characteristics were similar between groups (female, 51%; mean body mass index of 28; critically ill, 34%; central PN, 97%; median duration of PN, 7 days; mean energy provision PN, 25.4 kcal/kg/d; mean dextrose infusion rate, 2.31 mg/kg/min). Overall, metabolic complications developed in 58% of patients and occurred more frequently in older vs younger patients (65.7% vs 53.4%; P = .003). Multivariate logistic analysis demonstrated increased odds of metabolic complications in the older group (odds ratio, 1.55; 95% CI, 1.014-2.375)., Conclusions: Older hospitalized patients are more likely to develop a metabolic complication during their PN course than younger patients. This study heightens awareness that patients of advanced age are subject to metabolic complications; practitioners should anticipate and resolve complications in a timely manner., (© 2020 American Society for Parenteral and Enteral Nutrition.)

Purpose: The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2018 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby the majority of author participants (at least 5 of 8) considered the paper to be important. Guideline and consensus papers from professional organizations, important to practice but not scored, were also included. Results: A total of 117 articles were identified; 8 from the primary literature were voted by the group to be of high importance. An additional 13 organizational guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were reviewed. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The American Society for Parenteral and Enteral Nutrition (ASPEN) parenteral nutrition (PN) safety consensus recommendations advise a comprehensive education program and competency assessment for all healthcare professionals involved in the care of patients receiving PN. The ASPEN-model papers provide guidance for designing PN competencies for prescribers, pharmacists, and pharmacy technicians. The purpose of this research was to evaluate the impact of a comprehensive educational program that aligns with the ASPEN model on PN competency, attitudes, and perceptions in a multidisciplinary healthcare professional audience., Methods: Dietitians, pharmacists, and physicians attended a 3-hour ASPEN model-based educational program focused on PN order writing and review. Matched preeducation and posteducation competency assessments were completed by attendees. Attitudes and perceptions were also assessed before and after the educational program using 5-point Likert scales., Results: Ninety-seven subjects were included in the analysis. The majority of attendees were dietitians (53.6%), followed by pharmacists (45.4%). Overall, multidisciplinary competency assessment scores improved by an average of 12.6% (preassessment average of 62.7%, postassessment average of 75.3%, P < 0.0001). Nine out of 10 statements regarding PN attitudes and perceptions significantly improved on the 5-point Likert scales (P < 0.05)., Conclusion: A comprehensive PN educational program in alignment with the ASPEN model positively impacted multidisciplinary healthcare professional PN competency, attitudes, and perceptions. To optimize patient safety, local organizations and institutions should implement formalized training as outlined by the ASPEN model for healthcare professionals involved in the care of patients receiving PN., (© 2019 American Society for Parenteral and Enteral Nutrition.)

Background: The optimal time to initiate parenteral nutrition (PN) in critically ill adults in whom enteral nutrition is not feasible is controversial., Objective: The objectives were to compare in-hospital mortality and hospital length of stay in patients initiated on PN within 7 days or after 7 days of poor nutrient intake., Methods: This single-center, retrospective study included critically ill adult patients who received at least 2 consecutive days of PN during hospitalization from May 2014 to July 2016., Results: The median duration of PN (interquartile range) was 8 (5-13) days. In total, 110 patients received PN within 7 days of poor nutrient intake while 49 patients received PN after 7 days of poor nutrient intake. There was no statistically significant difference in in-hospital mortality between groups (29.09% vs 18.37%, P  = .1535). Patients initiated within 7 days had a significantly shorter median hospital length of stay than patients initiated after 7 days (20 days vs 27 days, P  = .0013). There were 69 patients who were classified as obese. Obese patients initiated within 7 days had a significantly shorter median hospital length of stay than obese patients initiated after 7 days (17 days vs 33 days, P  = .0007)., Conclusions: Time to initiation of PN did not impact in-hospital mortality. However, there was an association between early initiation of PN and a shorter hospital length of stay that was most pronounced among obese patients., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aims: To assess outcomes associated with student-led lay-responder cardiopulmonary resuscitation (CPR) education to community members., Methods: Healthcare students (87% pharmacy) were trained as American Heart Association (AHA)-certified CPR instructors and delivered CPR certification programs for the community through the AHA's Heartsaver® CPR Automated External Defibrillator (AED) certification course from August 2016 to January 2017. Knowledge acquisition was evaluated using 5 pre/ post-course questions adapted from the AHA Basic Life Support (BLS) certification course to be consistent with the AHA Heartsaver® CPR AED course learning objectives. Skill performance was evaluated using the AHA's standardized form for adult, child, and infant CPR assessment., Results: The majority of community member participants (n=105) were female (71%), African American (71%), 45-64 years of age (46%), employed (71%), college educated (50%), and had previous CPR training (63%). Participants demonstrated 100% success rate in correctly performing CPR skills. The mean percentage of correct responses increased from 36% for the pre-course questions to 85% for the post-course questions (p<0.001)., Conclusion: Healthcare students successfully provided CPR education to community members who then correctly demonstrated adult, child, and infant CPR skills. Data suggest that student-led CPR training has a positive impact on knowledge acquisition in community members.

Background: Unplanned pregnancy is a significant problem in Australia. Local data pertaining to use of the levonorgestrel-releasing intra-uterine device (LNG-IUD), and associated factors are limited. The aim of this analysis was to calculate prescribing rates of the LNG-IUD in Australia, including trends in prescribing and associations with socio-demographic factors, in order to increase understanding regarding potential use., Methods: We examined prescriptions for the LNG-IUD recorded in the national Pharmaceutical Benefits Scheme (PBS) from 2008 to 2012. Prescribing trends were examined according to patient age, remoteness of residential location, and proximity to relevant specialist health services. Associations between these factors and prescription rates were examined using poisson regression. Analyses were stratified by 5-year age-groups., Results: Age-adjusted prescription rates rose from 11.50 per 1000 women aged 15-49 (95% CI: 11.41-11.59) in 2008 to 15.95 (95% CI:15.85-16.01) in 2012. Prescription rates increased most among 15-19-year-olds but remain very low at 2.76 per 1000 women (95% CI: 2.52-3.01). Absolute increases in prescriptions were greatest among 40-44-year-olds, rising from 16.73 per 1000 women in 2008 (95% CI: 16.12-17.34) to 23.77 in 2012 (95% CI: 22.58-24.29). Rates increased significantly within all geographical locations (p < 0.01). Non-metropolitan location was significantly associated with increased prescribing rates, the association diminishing with increasing age groups., Conclusions: Prescription of LNG-IUD in Australia is very low, especially among young women and those in major cities. Service providers and young women may benefit from targeted education outlining use of the LNG-IUD, strengthened training and referral pathways. Disparities in prescription according to location require further investigation.

Purpose: The purpose of the article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2017 considered important to their clinical practice. The citation list was compiled into a spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby the majority (at least 5 out of 8 authors) considered the article to be of significance. Guideline and consensus articles from professional organizations, important to practice but not scored, were also included. Results: A total of 95 articles were identified; six from the primary literature were voted by the group to be of high importance. An additional 13 organizational guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were reviewed. Conclusion: It is recommended that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Purpose: Pharmacy students' performance and retention of Basic Life Support (BLS) skills were evaluated 120 days after completion of a peer-led BLS training program., Educational Activity and Setting: This was a single-center, parallel group, observational study. Doctor of pharmacy (PharmD) students in their third professional year completed a peer-led BLS training program (n = 148) and participated in a high-fidelity mannequin simulation activity 120 days later. Students were randomly assigned to rapid response teams (n = 24) of five to six members and the American Heart Association's standardized form for BLS assessment was used to assess BLS skills performance. The performance of skills was compared to that of students two years prior to the implementation of the peer-led BLS program., Findings and Discussion: Students who received peer-led BLS training demonstrated retention of BLS skills 120 days after the BLS training program. The teams also displayed significant improvement of the skills evaluated when compared to student teams prior to implementation of the peer-led training (n = 22). Improvement was demonstrated for assessment of responsiveness (96% vs. 41%, p < 0.001), assessment for breathing (100% vs. 32%, p < 0.001), assessment for pulse (96% vs. 36%, p < 0.001), and administration of appropriate ventilation (100% vs. 32%, p < 0.001). Numerical superiority was exhibited for high-quality cardiopulmonary resuscitation (CPR) initiation by teams who received peer-led training (100% vs. 86%, p = 0.101)., Summary: Students who received peer-led BLS training demonstrated significant improvement in BLS skills performance and retention 120 days after the training program. Data suggests that peer-led BLS training can improve student BLS skills performance and retention., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: A consensus statement recommends initial intravenous (IV) vancomycin dosing of 15-20 mg/kg every 8- 24 hours, with an optional 25- to 30-mg/kg loading dose. Although some studies have shown an association between weight and the development of vancomycin-associated nephrotoxicity, results have been inconsistent., Objective: To evaluate the correlation between incidence of nephrotoxicity associated with weight-based IV vancomycin dosing strategies in nonobese and obese patients., Methods: This retrospective cohort study evaluated hospitalized adult patients admitted who received IV vancomycin. Patients were stratified into nonobese (body mass index [BMI] <25 kg/m 2 ), obesity class I and II (BMI 30-39.9kg/m 2 ), and obesity class III (BMI≥40 kg/m 2 ) groups; patients who were overweight but not obese were excluded. Incidence of nephrotoxicity and serum vancomycin trough concentrations were evaluated., Results: Of a total of 62 documented cases of nephrotoxicity (15.1%), 13 (8.7%), 23 (14.3%), and 26 (26.3%) cases were observed in nonobese, obesity class I and II, and obesity class III groups, respectively ( P=0.002). Longer durations of therapy ( P<0.0001), higher initial maintenance doses in both total milligrams/day ( P=0.0137) and milligrams/kilogram ( P=0.0307), and any trough level >20 mg/L ( P<0.0001) were identified as predictors of development of nephrotoxicity. Concomitant administration of piperacillin/tazobactam, diuretics, and IV contrast were associated with development of nephrotoxicity ( P<0.005, all). Patients with class III obesity were 3-times as likely to develop nephrotoxicity when compared with nonobese patients (odds ratio [OR]=2.99; CI=1.12-7.94) and obesity class I and II patients (OR=3.14; CI=1.27-7.75)., Conclusions: Obesity and other factors are associated with a higher risk of vancomycin-associated nephrotoxicity.

Purpose: To assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2016 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the paper was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby the majority of author participants (at least 5 out of 8) considered the paper to be important. Guideline and consensus papers from professional organizations, important to practice but not scored, were also included. Results: A total of 103 articles were identified; 10 from the primary literature were voted by the group to be of high importance. An additional 11 organizational guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were reviewed. Conclusion: It is recommended that pharmacists, engaged in nutrition support therapy, be familiar with the majority of these articles as it pertains to their practice., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The American Society for Parenteral and Enteral Nutrition Adult Nutrition Support Core Curriculum describes clinical conditions that warrant cautious use of parenteral nutrition (CCWCPN). The Core Curriculum authors acknowledge there is no evidence for specific criteria suggested for the clinical conditions. Consequently, the purpose of this study was to determine the impact of a baseline CCWCPN on the development of subsequent metabolic complications in patients receiving parenteral nutrition (PN)., Methods: Adult patients initiated on PN from May 2014 to July 2015 at Cooper University Hospital were included in this retrospective study. The impact of a CCWCPN on the development of the following was determined: acid-base disturbances, hepatobiliary complications, hypercapnia, hyperchloremia, hyperglycemia, hypernatremia, hypertriglyceridemia, hypochloremia, hypoglycemia, hypokalemia, hypophosphatemia, and refeeding syndrome., Results: Three hundred forty-one patients were included (mean age, 61.7 years; mean duration of PN, 8.5 days; central PN, 97%). Metabolic complications occurred more frequently in patients with a baseline CCWCPN than without these conditions (77% vs 53%, P = .001). Subgroup analyses for the development of metabolic complications in patients with or without each individual baseline CCWCPN yielded the following statistically significant results: hypernatremia (93% vs 57%, P = .007) and hyperchloremia (86% vs 57%, P = .033)., Conclusions: Hospitalized adult patients with a baseline CCWCPN were more likely to develop a metabolic complication when receiving PN. Baseline hypernatremia and hyperchloremia were associated with the development of metabolic complications. Baseline CCWCPN should be recognized upon initiation of PN; practitioners should closely monitor patients to minimize subsequent metabolic complications.

Recent data have suggested that standard unfractionated heparin (UFH) protocols may over-anticoagulate obese patients. The goal of this retrospective study was to observe differences in anticoagulation parameters and safety outcomes for standardized antifactor Xa UFH protocols in obese and non-obese populations. Obese patients (N = 148) were identified over a 20-month period and matched to 148 non-obese patients based on age, gender, and admission date. Patients were included if they were on one of three approved UFH protocols [high (target antifactor Xa 0.3-0.7 IU/mL), moderate (0.3-0.5 IU/mL), or low (0.1-0.2 IU/mL) dose] for ≥24 consecutive hours and had ≥1 antifactor Xa level drawn during the infusion. Groups were compared for doses at first and second consecutive therapeutic antifactor Xa level, major bleeding, and in-hospital mortality. Obese patients required a significantly lower mean weight-based infusion rate to attain first therapeutic antifactor Xa level compared to non-obese patients in both the high dose (19.45 vs. 15.29 units/kg/h, p < 0.001) and the moderate dose populations (15.0 vs. 12.94 units/kg/h, p = 0.003). Similarly, patients in both the high and moderate dose populations had significant differences in mean infusion rates to attain second consecutive therapeutic antifactor Xa levels. There was no difference between infusion rates for the primary outcomes in the low dose population. There was no difference between groups in major bleeding or mortality outcomes. Similar to data using UFH protocols based on activated partial thromboplastin time, obese patients require lower weight-based UFH doses to attain therapeutic anticoagulation. Institutions using or changing to antifactor Xa based protocols may need to modify protocols for obese patients.

Intraneural lipomas, neurofibrolipomas, lipofibromatous hamartomas, and perineural lipomas are subsets of hamartomas that typically present as fibroadipose, soft tissue masses within the epineurium of a nerve. Several cases involving intraneural lipomas of the median nerve in the upper extremity have been reported; however, owing to the lesion's rare incidence in the foot and ankle, only a select few cases involving the superficial peroneal nerve have been reported. We present the first case of a tibial nerve intraneural lipoma in a 42-year-old female with a follow-up period of 2 years. We discuss the clinical presentation, distinguishing features, surgical procedures, and short-term outcome regarding this unique tumor., (Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective. To identify the temporal effect and factors associated with student pharmacist self-initiation of interventions during acute patient care advanced pharmacy practice experiences (APPE). Methods. During the APPE, student pharmacists at an academic medical center recorded their therapeutic interventions and who initiated the intervention throughout clinical rotations. At the end of the APPE student pharmacists completed a demographic survey. Results. Sixty-two student pharmacists were included. Factors associated with lower rates of self-initiated interventions were infectious diseases and pediatrics APPEs and an intention to pursue a postgraduate residency. Timing of the APPE, previous specialty elective course completion, and previous hospital experience did not result in any significant difference in self-initiated recommendations. Conclusion. Preceptors should not base practice experience expectations for self-initiated interventions on previous student experience or future intentions. Additionally, factors leading to lower rates of self-initiated interventions on infectious diseases or pediatrics APPEs should be explored.

Purpose: To assist the pharmacy clinician engaged in nutrition support in staying current with the most pertinent literature., Methods: Several experienced board-certified clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2014 and 2015 that they considered to be important to their practice. Only those articles available in print format were considered for potential inclusion. Articles available only in preprint electronic format were not evaluated. The citation list was compiled into a single spreadsheet where the author participants were asked to ascertain whether they considered the paper important to nutrition support pharmacy practice. A culled list of publications was then identified whereby the majority of author participants (at least 5 out of 8) considered the paper to be important., Results: A total of 108 articles were identified; 36 of which were considered to be of high importance. An important guideline article published in early 2016, but not ranked, was also included. The top-ranked articles from the primary literature were reviewed., Conclusion: It is recommended that the informed pharmacist, who is engaged in nutrition support therapy, be familiar with the majority of these articles.

Traumatic degloving injuries of the lower extremity are commonly diagnosed by soft tissue deficits and separation of soft tissue planes. The management of open degloving injuries is well documented with established treatment protocols. Because closed degloving injuries of the lower extremity are so rare, the protocol management is not well established. Unlike open degloving injuries, evidence of soft tissue injury and detachment of the tissue planes can be subtle. Owing to the rarity of these injuries, little has been described regarding the long-term outcomes. In the present report, 2 closed degloving cases are presented. The first case presented is of a 27-year-old railroad worker who sustained a severe closed degloving injury of his foot with digital soft tissue envelope transposition. The second case involved a 60-year-old automobile manufacturer, whose foot was crushed by a hydraulic fork lift, creating a degloving injury of the third, fourth, and fifth toes. The follow-up duration from the date of injury for patient 1 was 26 months and for patients 2 was 16 months. The purpose of presenting these cases is to report these rare injuries with the treatment, complications, and outcomes., (Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

The 2015 American College of Clinical Pharmacy (ACCP) Educational Affairs Committee was charged with developing a self-assessment guide for residency programs to quantitatively and qualitatively evaluate the outcomes of resident teaching curricula. After extensively reviewing the literature, the committee developed assessment rubrics modeled after the 2013 ACCP white paper titled "Guidelines for Resident Teaching Experiences" and the revised American Society of Health-System Pharmacists (ASHP) 2014 accreditation standards for PGY1 residencies, which place greater emphasis on the teaching and learning curriculum (TLC) than the previous accreditation standards. The self-assessment guide developed by the present committee can serve as an assessment tool for both basic and expanded TLCs. It provides the criteria for program goals, mentoring, directed readings with topic discussions, teaching experiences, and assessment methodology. For an expanded TLC, the committee has provided additional guidance on developing a teaching philosophy, becoming involved in interactive seminars, expanding teaching experiences, developing courses, and serving on academic committees. All the guidelines listed in the present paper use the measures "not present," "developing," and "well developed" so that residency program directors can self-assess along the continuum and identify areas of excellence and areas for improvement. Residency program directors should consider using this new assessment tool to measure program quality and outcomes of residency teaching experiences. Results of the assessment will help residency programs focus on areas within the TLC that will potentially benefit from additional attention and possible modification., (© 2016 Pharmacotherapy Publications, Inc.)

Unlabelled: Background Long-acting reversible contraceptives are an effective means of preventing unwanted pregnancies and associated negative consequences. The Sexual Health and Family Planning Association of Australia has called for efforts to address barriers to the uptake of long-acting reversible contraceptives (LARCs) in Australia, where LARC uptake is thought to be low, though comprehensive data describing use and associated factors is scarce. The aims of this study were to describe patterns of prescriptions for the etonogestrel-releasing subdermal implant (SDI) in Australia, 2008-2012, and associated factors., Methods: Records of prescriptions written through Australia's Pharmaceutical Benefits Scheme from 2008 to 2012 were obtained, including patient age and geographic location. Direct, age-standardised rates (ASR) of prescriptions were calculated for each year and location, with multivariate analysis used to examine associations between prescription rates and patient age, location and proximity to family planning clinics (FPC) or Aboriginal Medical Services (AMS)., Results: ASR of prescriptions rose ~6% per year (OR 1.06, 95%CI: 1.05-1.06) from 13.05 per 1000 (2008) to 15.76 per 1000 (2012; P<0.01). Rates were highest among 15- to 19-year-olds, increasing from 20.81 (2008) to 29.09 per 1000 (2012: P<0.01) and lowest among 45- to 49-year-olds, increasing from 3.37 to 3.73 per 1000 (P<0.01). ASR by location were significantly higher in regional than metropolitan areas., Conclusions: This is the first analysis of SDI prescriptions across all ages and regions of Australia. Uptake of SDI in Australia is increasing but remains low. Significant associations were found between prescription rates and patient age and residence in regional/remote areas.

Background: Co-payments for medical services have been a controversial topic in Australia., Objective: The aim of this study was to assess parents' perspectives on the potential impact of co-payments for general practice and emergency department (ED) services for children., Methods: A cross-sectional survey was conducted between May and November 2014 in the EDs of four metropolitan hospitals in Melbourne. The participants were 1531 parents of children presenting with lower urgency conditions. The outcome measures were the potential impact of a $7 general practice co-payment or a $7 ED co-payment on the use of services for children., Results: Seventy-three per cent (n = 1089) of parents reported that a $7 general practice co-payment would not increase their use of EDs for lower urgency problems for their children. Increased use was associated with younger parent or guardian age and lower household income. Ninety per cent (n = 1343) reported that a $7 ED co-payment would not have an impact on ED attendance. Impact was associated with younger parent or guardian age and lower income., Discussion: For most parents presenting to an ED with their child, a $7 general practice or ED co-payment is unlikely to affect health service use, although significant differences in response were found according to parent or guardian age and household income.

Objective: To assess pharmacy students' ability to retain advanced cardiac life support (ACLS) knowledge and skills within 120 days of previous high-fidelity mannequin simulation training., Design: Students were randomly assigned to rapid response teams of 5-6. Skills in ACLS and mannequin survival were compared between teams some members of which had simulation training 120 days earlier and teams who had not had previous training., Assessment: A checklist was used to record and assess performance in the simulations. Teams with previous simulation training (n=10) demonstrated numerical superiority to teams without previous training (n=12) for 6 out of 8 (75%) ACLS skills observed, including time calculating accurate vasopressor infusion rate (83 sec vs 113 sec; p=0.01). Mannequin survival was 37% higher for teams who had previous simulation training, but this result was not significant (70% vs 33%; p=0.20)., Conclusion: Teams with students who had previous simulation training demonstrated numerical superiority in ACLS knowledge and skill retention within 120 days of previous training compared to those who had no previous training. Future studies are needed to add to the current evidence of pharmacy students' and practicing pharmacists' ACLS knowledge and skill retention.

Unlabelled: Background Patterns of population susceptibility to sexually transmissible infections may be influenced by various social determinants of health, however these receive relatively little attention. Income inequality is one such determinant that has been linked to a number of poor health outcomes. The objective of this analysis was to determine whether there is an association between income inequality and Neisseria gonorrhoeae notification rates when measured at the country level., Methods: Gini coefficients, gonorrhoea notification rates among women, per capita gross domestic product and approximate size of female population were obtained for 11 countries of the OECD. Linear regression was used to measure the association between income inequality and gonorrhoea notification rates, using generalised estimation equations (GEE) to control for the non-independence of repeat measures from particular countries., Results: A total of 36 observations from 11 countries were included. Gini coefficients ranged from 0.21 to 0.38 and gonorrhoea notifications from 0.7 to 153 per 100000 females. Significant associations were found between country-level income inequality and gonorrhoea notification rates among women (b=17.79 (95% CI: 10.64, 24.94, P<0.01)., Conclusions: Significant associations were found, highlighting the importance of acknowledging and accounting for social determinants of sexual health and suggesting that further research in this arena may be fruitful.

Objective: To estimate chlamydia prevalence among 16-29-year-olds attending general practice clinics in Australia., Design, Participants and Setting: A cross-sectional survey was conducted from May 2010 to December 2012. Sexually experienced 16-29-year-olds were recruited from 134 general practice clinics in 54 rural and regional towns in four states and in nine metropolitan clinics (consecutive patients were invited to participate). Participants completed a questionnaire and were tested for chlamydia., Main Outcome Measure: Chlamydia prevalence., Results: Of 4284 participants, 197 tested positive for chlamydia (4.6%; 95% CI, 3.9%-5.3%). Prevalence was similar in men (5.2% [65/1257]; 95% CI, 3.9%-6.4%) and women (4.4% [132/3027]; 95% CI, 3.5%-5.2%) (P = 0.25) and high in those reporting genital symptoms or a partner with a sexually transmissible infection (STI) - 17.0% in men (8/47; 95% CI, 2.8%-31.2%); 9.5% in women (16/169; 95% CI, 5.1%-13.8%). Nearly three-quarters of cases (73.4% [130/177]) were diagnosed in asymptomatic patients attending for non-sexual health reasons, and 83.8% of all participants (3258/3890) had attended for non-sexual health reasons. Prevalence was slightly higher in participants from rural and regional areas (4.8% [179/3724]; 95% CI, 4.0%-5.6%) than those from metropolitan areas (3.1% [17/548]; 95% CI, 1.5%-4.7%) (P = 0.08). In multivariable analysis, increasing partner numbers in previous 12 months (adjusted odds ratio [AOR] for three or more partners, 5.11 [95% CI, 2.35-11.08]), chlamydia diagnosis in previous 12 months (AOR, 4.35 [95% CI, 1.52-12.41]) and inconsistent condom use with most recent partner (AOR, 2.90 [95% CI, 1.31-6.40]) were significantly associated with chlamydia in men. In women, increasing partner numbers in previous 12 months (AOR for two partners, 2.59 [95% CI, 1.59-4.23]; AOR for three or more partners, 3.58 [95% CI, 2.26-5.68]), chlamydia diagnosis in previous 12 months (AOR, 3.13 [95% CI, 1.62-6.06]) and age (AOR for 25-29-year-olds, 0.23 [95% CI, 0.12-0.44]) were associated with chlamydia., Conclusions: Chlamydia prevalence is similar in young men and women attending general practice. Testing only those with genital symptoms or a partner with an STI would have missed three-quarters of cases. Most men and women are amenable to being tested in general practice, even in rural and regional areas.

The reactions of 1,3,8,10-tetrakis(4'-fluorophenyl)-4,5,6,7-tetrathiocino[1,2-b:3,4-b']diimidazolyl-2,9-dithione (4) and molecular diiodine afforded spoke adducts with stoichiometries 4·I2 and 4·3I2 , isolated in the compound 4·3I2·xCH2Cl2·(1-x)I2 (x=0.70), and characterized by single-crystal XRD and FT-Raman spectroscopy. The nature of the reaction products was investigated under the prism of theoretical calculations carried out at the DFT level. The structural data, FT-Raman spectroscopy, and quantum mechanical calculations agree in indicating that the introduction of fluorophenyl substituents results in a lowering of the Lewis basicity of this class of bis(thiocarbonyl) donors compared with alkyl-substituted tetrathiocino donors and fluorine allows for extended interactions that are responsible for solid-state crystal packing., (Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

We report a case of an inadvertent increase in the international normalized ratio (INR) after the addition of bismuth subsalicylate for the treatment of diarrhea in an enterally fed patient receiving warfarin therapy. A 56-year-old Caucasian female presented to the trauma intensive care unit (ICU) with multiple lower extremity fractures. Warfarin was initiated for deep vein thrombosis prophylaxis due to the patient's inability to ambulate. The target INR was 2-3. Continuous intragastric enteral feeding was withheld 1 hour before and 1 hour after intragastric administration of warfarin. Bismuth subsalicylate 30 mL every 4 hours was prescribed for diarrhea. Within 3 days after starting bismuth subsalicylate therapy, the patient's INR increased from 2.56 to 3.54 and minor bleeding was noted from the patient's tracheostomy site. No significant change in warfarin dosage, variability in vitamin K intake, or medications that potentially alter warfarin metabolism were present during the unexpected rise in INR. When the bismuth subsalicylate was discontinued, the patient's INR stabilized into the target range on the same warfarin dose given at the time of the supratherapeutic INR. Salicylate displaces warfarin from plasma protein binding sites and may result in a significant increase in INR secondary to redistribution of warfarin to the free active form. Evaluation of this case report using the Drug Interaction Probability Scale and Naranjo Adverse Drug Reaction Probability Scale yielded scores consistent with a probable adverse drug interaction. Bismuth subsalicylate exaggerates warfarin's anticoagulant response and its concurrent use during warfarin therapy should be avoided.

Aim: Older people receiving informal care at home appear at high falls risk. This study investigates frequency, circumstances and factors associated with falls risk for older care recipients, and their informal caregivers., Methods: Ninety-six dyads, recruited from caregiver agencies, underwent a home assessment, including falls risk, function, depression, quality of life, self-rated health and carer burden., Results: Care recipients were at high falls risk. In the past 12 months, 58% had fallen and 26% twice or more. Common falls risk factors were polypharmacy, multiple medical conditions and requiring functional assistance. Caregivers exhibited multiple health problems, moderate burden and reduced quality of life. Where care recipients had high falls risk, caregivers had significantly higher carer burden and depression. Low functional level and high care recipient health problems were independently associated with risk of falling (P < 0.05)., Conclusion: Strategies to reduce falls risk in this cohort are necessary, together with supporting the needs of the caregiver., (© 2010 The Authors. Australasian Journal on Ageing © 2010 ACOTA.)

The delta polymorph of sulfanilamide (or 4-aminobenzenesulfonamide), C(6)H(8)N(2)O(2)S, displays an overall three-dimensional hydrogen-bonded network that is dominated by a two-dimensional substructure with R(2)(2)(8) rings; these result from dimeric N-H...O interactions between adjacent sulfonamide groups. This study shows how the polymorphism of sulfanilamide is linked to its versatile hydrogen-bonding capabilities.

Numerical simulations were used to design a variety of high-Q resonant cavities for integration into a terahertz 2D photonic crystal waveguide. After fabrication, the transmission characteristics of each integrated cavity were explored. These photonic waveguide-coupled cavities demonstrate resonances with linewidths approaching 10 GHz. The results compare favorably to previous observations of rectangular waveguide cavities. Good agreement between the experimental results and the numerical simulations was obtained.

Polymorph VI of 4-amino-N-(2-pyridyl)benzenesulfonamide, C(11)H(11)N(3)O(2)S, is monoclinic (space group P2(1)/n). The asymmetric unit contains two different tautomeric forms. The structure displays N-H...N and N-H...O hydrogen bonding. The two independent molecules form two separate two- and three-dimensional hydrogen-bonded networks which interpenetrate. The observed patterns of hydrogen bonding are analogous to those in polymorph I of sulfathiazole.

HIV-infected individuals may progressively lose both HIV-specific and unrelated CTL responses despite the high number of circulating CD8+ T cells. In this study, we report that approximately 25% of HIV+ donors produced TGF-beta(1) in response to stimulation with HIV proteins or peptides. The production of TGF-beta(1) was sufficient to significantly reduce the IFN-gamma response of CD8+ cells to both HIV and vaccinia virus proteins. Ab to TGF-beta reversed the suppression. We found the source of the TGF-beta(1) to be predominantly CD8+ cells. Different peptide pools stimulated TGF-beta(1) and IFN-gamma in the same individual. The TGF-beta(1) secreting cells have distinct peptide specificity from the IFN-gamma producing cells. This represents an important mechanism by which an HIV-specific response can nonspecifically suppress both HIV-specific and unrelated immune responses.

The aim of this study was to examine the outcome of epiglottitis in a small paediatric institution. Over the 5 year period October 1986 to September 1991, 44 children (of whom 15 were retrieved) with epiglottitis were admitted to the only paediatric intensive care facility in the Hunter Region. The so-called classical features were often absent. Forty of the 44 children were intubated. The mean length of intubation was 22 h and the mean length of hospital stay was only 2 1/2 days. One child had a respiratory arrest prior to intubation but made a complete recovery; one child had a coexistent submental/submandibular fascial space infection; 16 (36%) had abnormal chest radiographs. Five children had post-extubation stridor with one of these children left with residual hoarseness. Epiglottitis can be managed safely in a small paediatric intensive care unit with acceptable short-term and long-term complications.