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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2010.06.008 Byline: Megan K. Mills (a), Iris Faraklas (a), Cherisse Davis (a), Gregory J. Stoddard (b), Jeffrey Saffle (a) Keywords: Necrotizing soft-tissue infection; Necrotizing fasciitis; National Surgical Quality Improvement Program; Outcomes; Mortality Abstract: Necrotizing soft-tissue infections (NSTIs) are a group of uncommon, rapidly progressive, potentially fatal disorders. The National Surgical Quality Improvement Program (NSQIP) Registry was used to determine current data on the incidence, treatment, and outcomes of NSTIs. Author Affiliation: (a) Department of Surgery, 3B-306, University of Utah, Health Center, 50 N. Medical Dr, Salt Lake City, UT 84132, USA (b) Department of Internal Medicine, University of Utah Health Center, Salt Lake City, UT Article History: Received 10 March 2010; Revised 15 June 2010 Article Note: (footnote) Supported by grant number 5UL1 RR025764 from the NIH National Center for Research Resources.

Abstract: The purpose of this study was to compare a social marketing campaign to a 5-a-Day curriculum-only intervention, and to no intervention on increasing fruit and vegetable consumption. Researchers developed [...]

Aging increases the risk of atherosclerotic cardiovascular disease which is associated with arterial senescence; however, the mechanisms responsible for the development of cellular senescence in endothelial cells (ECs) and vascular smooth muscle cells (VSMCs) remain elusive. Here, we study the effect of aging on arterial DNA damage and telomere dysfunction. Aging resulted in greater DNA damage in ECs than VSMCs. Further, telomere dysfunction–associated DNA damage foci (TAF: DNA damage signaling at telomeres) were elevated with aging in ECs but not VMSCs. Telomere length was modestly reduced in ECs with aging and not sufficient to induce telomere dysfunction. DNA damage and telomere dysfunction were greatest in atheroprone regions (aortic minor arch) versus non-atheroprone regions (thoracic aorta). Collectively, these data demonstrate that aging results in DNA damage and telomere dysfunction that is greater in ECs than VSMCs and elevated in atheroprone aortic regions.

To evaluate whether the implementation of clinical pathways, known as pediatric rapid response algorithms, within an existing rapid response system was associated with an improvement in clinical outcomes of hospitalized children.We retrospectively identified patients admitted to the PICU as unplanned transfers from the general medical and surgical floors at a single, freestanding children’s hospital between July 1, 2017, and January 31, 2020. We examined the impact of the algorithms on the rate of critical deterioration events. We used multivariable Poisson regression and an interrupted time series analysis to measure 2 possible types of change: an immediate implementation effect and an outcome trajectory over time.We identified 892 patients (median age: 4 [interquartile range: 1–12] years): 615 in the preimplementation group, and 277 in the postimplementation group. Algorithm implementation was not associated with an immediate change in the rate of critical deterioration events but was associated with a downward rate trajectory over time and a postimplementation trajectory that was significantly less than the preimplementation trajectory (trajectory difference of −0.28 events per 1000 non-ICU patient days per month; 95% confidence interval −0.40 to −0.16; P < .001).Algorithm implementation was associated with a decrease in the rate of critical deterioration events. Because of the study’s observational nature, this association may have been driven by unmeasured confounding factors and the chosen implementation point. Nevertheless, the results are a promising start for future research into how clinical pathways within a rapid response system can improve care of hospitalized patients.

Although febrile neutropenia (FN) is a frequent complication in children with cancer receiving chemotherapy, there remains significant variability in selection of route (intravenous [IV] vs oral) and length of therapy. We implemented a guideline with a goal to change practice from using IV antibiotics after hospital discharge to the use of step-down oral therapy with levofloxacin for most children with FN until absolute neutrophil count > 500. The objectives of this study were to determine the impact of this guideline on home IV antibiotic use, and to evaluate the safety of implementation of this guideline.

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IMPORTANCE: Use of empirical broad-spectrum antibiotics for pneumonia has increased owing to concern for resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA). The association of empirical anti-MRSA therapy with outcomes among patients with pneumonia is unknown, even for high-risk patients. OBJECTIVE: To compare 30-day mortality among patients hospitalized for pneumonia receiving empirical anti-MRSA therapy vs standard empirical antibiotic regimens. DESIGN, SETTING, AND PARTICIPANTS: Retrospective multicenter cohort study was conducted of all hospitalizations in which patients received either anti-MRSA or standard therapy for community-onset pneumonia in the Veterans Health Administration health care system from January 1, 2008, to December 31, 2013. Subgroups of patients analyzed were those with initial intensive care unit admission, MRSA risk factors, positive results of a MRSA surveillance test, and positive results of a MRSA admission culture. Primary analysis was an inverse probability of treatment–weighted propensity score analysis using generalized estimating equation regression; secondary analyses included an instrumental variable analysis. Statistical analysis was conducted from June 14 to November 20, 2019. EXPOSURES: Empirical anti-MRSA therapy plus standard pneumonia therapy vs standard therapy alone within the first day of hospitalization. MAIN OUTCOMES AND MEASURES: Risk of 30-day all-cause mortality after adjustment for patient comorbidities, vital signs, and laboratory results. Secondary outcomes included the development of kidney injury and secondary infections with Clostridioides difficile, vancomycin-resistant Enterococcus species, or gram-negative bacilli. RESULTS: Among 88 605 hospitalized patients (86 851 men; median age, 70 years [interquartile range, 62-81 years]), empirical anti-MRSA therapy was administered to 33 632 (38%); 8929 patients (10%) died within 30 days. Compared with standard therapy alone, in weighted propensity score analysis, empirical anti-MRSA therapy plus standard therapy was significantly associated with an increased adjusted risk of death (adjusted risk ratio [aRR], 1.4 [95% CI, 1.3-1.5]), kidney injury (aRR, 1.4 [95% CI, 1.3-1.5]), and secondary C difficile infections (aRR, 1.6 [95% CI, 1.3-1.9]), vancomycin-resistant Enterococcus spp infections (aRR, 1.6 [95% CI, 1.0-2.3]), and secondary gram-negative rod infections (aRR, 1.5 [95% CI, 1.2-1.8]). Similar associations between anti-MRSA therapy use and 30-day mortality were found by instrumental variable analysis (aRR, 1.6 [95% CI, 1.4-1.9]) and among patients admitted to the intensive care unit (aRR, 1.3 [95% CI, 1.2-1.5]), those with a high risk for MRSA (aRR, 1.2 [95% CI, 1.1-1.4]), and those with MRSA detected on surveillance testing (aRR, 1.6 [95% CI, 1.3-1.9]). No significant favorable association was found between empirical anti-MRSA therapy and death among patients with MRSA detected on culture (aRR, 1.1 [95% CI, 0.8-1.4]). CONCLUSIONS AND RELEVANCE: This study suggests that empirical anti-MRSA therapy was not associated with reduced mortality for any group of patients hospitalized for pneumonia. These results contribute to a growing body of evidence that questions the value of empirical use of anti-MRSA therapy using existing risk approaches.

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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2009.05.022 Byline: Jennifer E. Warren (a), Lesa M. Nelson (c), Gregory J. Stoddard (b), M. Sean Esplin (a), Michael W. Varner (a), Robert M. Silver (a) Keywords: cervical insufficiency; IL-10; inflammation; polymorphisms Abstract: Our objective was to determine whether polymorphisms in the promoter region of the interleukin-10 gene are more common in women with cervical insufficiency compared with controls. Author Affiliation: (a) Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah (b) Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah (c) Taueret Laboratories, Salt Lake City, Utah Article History: Received 2 September 2008; Revised 12 February 2009; Accepted 14 May 2009 Article Note: (footnote) Cite this article as: Warren JE, Nelson LM, Stoddard GJ, et al. Polymorphisms in the promoter region of the interleukin-10 (IL-10) gene in women with cervical insufficiency. Am J Obstet Gynecol 2009;201:372.e1-5.

Background and purposeBlood pressure variability has been found to contribute to worse outcomes after intravenous tissue plasminogen activator, but the association has not been established after intra-arterial therapies.MethodsWe retrospectively reviewed patients with an ischemic stroke treated with intra-arterial therapies from 2005 to 2015. Blood pressure variability was measured as standard deviation (SD), coefficient of variation (CV), and successive variation (SV). Ordinal logistic regression models were fitted to the outcome of the modified Rankin Scale (mRS) with univariable predictors of systolic blood pressure variability. Multivariable ordinal logistic regression models were fitted to the outcome of mRS with covariates that showed independent predictive ability (P<0.1).ResultsThere were 182 patients of mean age 63.2 years and 51.7% were female. The median admission National Institutes of Health Stroke Scalescore was 16 and 47.3% were treated with intravenous tissue plasminogen activator. In a univariable ordinal logistic regression analysis, systolic SD, CV, and SV were all significantly associated with a 1-point increase in the follow-up mRS (OR 2.30–4.38, all P<0.002). After adjusting for potential confounders, systolic SV was the best predictor of a 1-point increase in mRS at follow-up (OR 2.63–3.23, all P<0.007).ConclusionsIncreased blood pressure variability as measured by the SD, CV, and SV consistently predict worse neurologic outcomes as measured by follow-up mRS in patients with ischemic stroke treated with intra-arterial therapies. The SV is the strongest and most consistent predictor of worse outcomes at all time intervals.

IMPORTANCE: Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of neurotoxic chemotherapy resulting in pain, sensory loss, and decreased quality of life. Few studies have prospectively examined the relationship between sensory neuropathy symptoms, falls, and fall-related injuries for patients receiving neurotoxic chemotherapy. OBJECTIVE: To determine the association between the symptoms of CIPN and the risk of falls for patients receiving neurotoxic chemotherapy. DESIGN, SETTING, AND PARTICIPANTS: In this secondary analysis of a prospective study, 116 patients with breast, ovarian, or lung cancer who were beginning neurotoxic chemotherapy with a taxane or platinum agent were recruited from oncology clinics. These patients would call a novel automated telephone system daily for 1 full course of chemotherapy. The telephone system (SymptomCare@Home) used a series of relevant CIPN questions to track symptoms on a 0 to 10 ordinal scale and contained a questionnaire about falls. Those reporting a numbness and tingling severity score of 3 or greater for at least 10 days were considered to have significant CIPN symptoms and were compared with those patients who did not. Data analysis was performed in November 2015. EXPOSURE: Chemotherapy with a neurotoxic taxane or platinum agent. MAIN OUTCOMES AND MEASURES: Patient-reported falls or near falls and fall-related injuries. The hypothesis was generated after data collection but prior to data analysis. RESULTS: Of the 116 patients who started neurotoxic chemotherapy (mean [SD] age was 55.5 [11.9] years, and 109 [94.0%] were female), 32 met the predetermined criteria for CIPN symptoms. The mean duration of follow-up was 62 days, with 51 telephone calls completed per participant. Seventy-four falls or near falls were reported. The participants with CIPN symptoms were nearly 3 times more likely to report a fall or near fall than the participants without CIPN symptoms (hazard ratio, 2.67 [95% CI, 1.62-4.41]; P &lt; .001). The participants with CIPN symptoms were more likely than the participants without CIPN symptoms to obtain medical care for falls (8 of 32 participants with CIPN symptoms [25.0%] vs 6 of 84 participants without CIPN symptoms [7.1%]; P = .01). CONCLUSIONS AND RELEVANCE: These findings suggest that the sensory symptoms of CIPN are an indicator of an increased risk of falling and an increased use of health care resources. This study demonstrates the utility of a novel telephone-based system to track neuropathy symptoms. Careful monitoring and coaching of patients receiving neurotoxic chemotherapy for new sensory symptoms may facilitate more effective fall prevention strategies.

To compare the prevalence of hospitalizations for ambulatory care sensitive conditions (ACSC) in children with and without autism spectrum disorder (ASD) and to compare inpatient health care utilization (total charges and length of stay) for the same conditions in children with and without ASD.

Supplemental Digital Content is Available in the Text.In a clinical trial of 2 equivalent operations, randomized to exposure or nonexposure of information relevant to surgical cost of care, those exposed to cost information were more likely to choose the less costly procedure. Prior provision of pertinent charge information may be a potential opportunity for reducing health care costs.

Intraplaque hemorrhage (IPH) is associated with acute and future stroke. IPH is also associated with lumen markers of stroke risk including stenosis, plaque thickness, and ulceration. Whether IPH adds further predictive value to these other variables is unknown. The purpose of this study was to determine whether IPH improves carotid-source stroke prediction.

The prudent use of prescription opiates is a central aspect of current postsurgical pain management, but surgeons have no guidelines on appropriate duration of opiate treatment. Furthermore, there are no established data on the effect of physician counseling on the duration of opiate use postoperatively.

Bleeding is an important cause of morbidity and mortality in patients with continuous-flow left ventricular assist devices (LVADs). Reduced pulsatility has been implicated as a contributing cause. The aim of this study was to assess the effects of different degrees of pulsatility on the incidence of nonsurgical bleeding.

Purpose: Using a large, retrospective cohort from the Utah Population Database, we assess how well family history predicts who will acquire colorectal cancer during a 20-year period.Methods: Individuals were selected between ages 35 and 80 with no prior record of colorectal cancer diagnosis, as of the year 1985. Numbers of colorectal cancer-affected relatives and diagnosis ages were collected. Familial relative risk and absolute risk estimates were calculated. Colorectal cancer diagnoses in the cohort were counted between years 1986 and 2005. Cox regression and Harrell's C were used to measure the discriminatory power of resulting models.Results: A total of 431,153 individuals were included with 5,334 colorectal cancer diagnoses. Familial relative risk ranged from 0.83 to 12.39 and 20-year absolute risk from 0.002 to 0.21. With familial relative risk as the only predictor, Harrell's C = 0.53 and with age only, Harrell's C = 0.66. Familial relative risk combined with age produced a Harrell's C = 0.67.Conclusion: Family history by itself is not a strong predictor of exactly who will acquire colorectal cancer within 20 years. However, stratification of risk using absolute risk probabilities may be more helpful in focusing screening on individuals who are more likely to develop the disease.

Introduction. Over the past three decades, significant advances in treatment have improved the mortality of children with cardiac disease. The effect of these advances on the prevalence of arterial ischemic stroke (AIS) is unknown. We describe AIS in children with cardiac disease in the modern era.

ABSTRACTParasitic infection is uncommon in the United States, but surveys suggest that physicians test when the presence of parasites is unlikely and fail to order appropriate testing when suspicion is high. Numerous studies confirm that immunoassays are more sensitive for Giardiaand Cryptosporidiumdetection, but our experience was that physicians preferentially used ovum and parasite examination (O&P). We conducted a retrospective study of fecal parasite testing at a referral laboratory nationally (1997 to 2006) and during a Cryptosporidiumoutbreak (Utah, 2007) to correlate physician use of O&P and enzyme immunoassays (EIAs) with the yield of parasites detected. Nationally, of 170,671 episodes, 76.0% (n= 129,732) included O&P, 27.9% (n= 47,666) included GiardiaEIA, and 5.7% (n= 9,754) included CryptosporidiumEIA. Most pathogens were Giardiaor Cryptosporidium. More episodes were positive when EIA was performed (n= 1,860/54,483 [3.4%]) than when O&P only was performed (n= 1,667/116,188 [1.4%]; P< 0.001), and EIA was more sensitive than O&P. However, more O&P results were positive among patients with both O&P and EIA performed (2.5%) than among those with O&P only performed (1.4%; P< 0.001), suggesting that patients tested by O&P only may have been at lower risk. During the first 10 weeks of the outbreak, physicians also preferentially used O&P over EIA, but no Cryptosporidiumcases were detected by O&P. We conclude that clinicians frequently use O&P testing when test performance and epidemiology support the use of immunoassays or no testing. We recommend that stool O&P be limited to patients with negative immunoassay results and persistent symptoms or individuals at increased risk for non-Giardia, non-Cryptosporidiuminfection. An evidence-based algorithm for the evaluation of patients with suspected intestinal parasitic infection is proposed.

Objective.To increase and sustain hospital-wide compliance with hand hygiene through a long-term ongoing multidimensional improvement program emphasizing behavioral factors.Design.Quasi-experimental short study (August 2000-November 2001) and descriptive time series (April 2003-December 2006).Setting.A 450-bed teaching tertiary-care hospital.Interventions.An initial intervention bundle was introduced in pilot locations that addressed cognitive behavioral factors, which included access to alcohol sanitizer, education, and ongoing audit and feedback. The bundle was subsequently disseminated hospital-wide, along with a novel approach focused on behavior modification through positive reinforcement and annually changing incentives.Results.A total of 36,123 hand hygiene opportunities involving all categories of healthcare workers from 12 inpatient units were observed from October 2000 to October 2006. The rate of compliance with hand hygiene significantly improved after the intervention in 2 cohorts over the first year (from 40% to 64% of opportunities and from 34% to 49% of opportunities; P< .001, compared with the control group). Mean compliance rates ranged from 19% to 41% of 4174 opportunities (at baseline), increased to the highest levels of 73%–84% of 6,420 opportunities 2 years after hospital-wide dissemination, and remained improved at 59%–81% of 4,990 opportunities during year 6 of the program.Conclusion.This interventional cohort study used a behavioral change approach and is one of the earliest and largest institution-wide programs promoting alcohol sanitizer from the United States that has shown significant and sustained improvements in hand hygiene compliance. This creative campaign used ongoing frequent audit and feedback with novel use of immediate positive reinforcement at an acceptable cost to the institution.

ABSTRACTStudies about the relationship between antibiotic consumption and carriage of antibiotic-resistant Escherichia coliin individual patients have yielded conflicting results. The goal of this study was to identify individual- and household-level factors associated with carriage of ampicillin (AMP)-resistant E. coliduring consumption of a course of oral antibiotics. We enrolled outpatients and their families in a prospective household study of AMP-resistant or AMP-susceptible E. colicarriage. Two kinds of index patients were identified. Group 1 consisted of outpatients who were being initiated on a new antibiotic course at the time of a clinic visit, and group 2 consisted of outpatients not starting antibiotics. Each participant was asked to submit three stool swab samples (at baseline, week 1, and week 4) and to complete a questionnaire. Antimicrobial susceptibility testing was performed on each phenotypically distinct E. colicolony. The study included 149 group 1 households (total, 570 participants) and 38 group 2 households (total, 131 participants). AMP-resistant E. coliwas recovered from 29% of stool samples. Observed associations with antibiotic exposure varied by drug class. Penicillins, which were the most frequently prescribed drug class, were associated with a modest increase in AMP-resistant E. colicarriage and a modest decrease in AMP-susceptible E. colicarriage. Neither change by itself was statistically significant. Macrolides were associated with reduced carriage of both AMP-resistant E. coliand AMP-susceptible E. coli(P< 0.05). Both AMP-resistant and AMP-susceptible E. colidemonstrated household clustering (P< 0.001). In summary, the overall effect of antibiotics on individual risk of carriage of AMP-resistant E. coliwas small. However, even a modest alteration of the competitive balance between AMP-resistant and AMP-susceptible E. colimay promote population spread of resistant E. coli. Examining changes in both resistant and susceptible organisms in antibiotic-treated individuals and their close contacts improves understanding of antibiotic selection pressure.

Background: Recent changes in national reimbursement policies expand the ability of pharmacists to seek reimbursement for cognitive services. The quality of pharmacist-provided cognitive services has, until now, remained unassessed. Pharmacists should demonstrate the quality and value of their work to ensure the continued and expanded acceptance of reimbursement for their services. A preliminary step in assessing quality is to compare agreement between pharmacists for basic problem identification.Objective: To quantify agreement between pharmacist reviewers for problem identification among Utah Medicaid recipients.Methods: Five pharmacists retrospectively reviewed drug regimens, patient characteristics, diagnosis codes, and procedures for 80 Medicaid patients in September 2008 and identified drug-related problems (DRPs) in 15 predetermined categories. Data for each patient were reviewed twice, and each combination of 2 pharmacists reviewed the same 8 patients' information. We calculated a reliability coefficient to compare the number of DRPs identified and used prevalence and bias adjusted κ (PABAK) to determine interrater reliability for the presence of a specific DRP.Results: Of the 15 DRPs categorized by pharmacist reviewers, 1 (untreated indications) had a PABAK coefficient of 0.20, indicating a relatively low level of agreement between reviewers. All other DRP categories had good to excellent agreement, with PABAK coefficients ranging between 0.43 and 0.98.Conclusions: Pharmacist reviewers exhibited less variability in DRP identification or categorization than had been expected for most categories. This work supports the conclusion that pharmacists in our center provide a basic and necessary level of quality for problem assessment. Future work is needed to document the impact of this quality on patient outcomes.

Influenza virus infections cause significant morbidity and often result in hospitalization in children. Many children with influenza seek care in emergency settings during seasonal influenza epidemics. We hypothesized that certain features could predict the need for hospitalization in children with influenza.

Background: Opioid analgesics remain a mainstay in the treatment of pain associated with surgical procedures. Such use is associated with adverse drug events (ADEs).Objective: To investigate the impact of opioid-related ADEs on total hospital costs and length of stay (LOS) in adult surgical patients.Methods: This was a retrospective matched cohort study using data from computerized medical records. ADE cases were prospectively detected using computerized surveillance and verified by pharmacists. Surgical patients treated at LDS Hospital in Salt Lake City from January 1, 1998, to December 31, 2003, were included. The primary outcomes were costs and hospital LOS associated with opioid-related ADEs and the relationship of opioid dose to ADE events.Results: Patients experiencing opioid-related ADEs had significantly increased median total hospital costs (7.4% increase; 95% CI 3.83 to 10.96; p < 0.001) and increased median LOS (10.3% increase; 95% CI 6.5 to 14.2; p < 0.001) compared with matched non-ADE contrals. The increased costs attributable to ADEs, by surgery type, were general surgery ($676.51; 95% CI 351.50 to 1001.50), orthopedics ($861.50; 95% CI 448.20 to 1274.80), and obstetrics/gynecology ($540.90; 95% CI 281.40 to 800.40). Similarly, increased LOS attributable to ADEs, by surgery type, were general surgery (0.64 days; 95% CI 0.40 to 0.88), orthopedics (0.52 days; 95% CI 0.33 to 0.71), and obstetrics/gynecology (0.53 days; 95% CI 0.33 to 0.72). Higher doses of opioids were associated with increased risk of experiencing ADEs (OR 1.3; 95% CI 1.07 to 1.60; p = 0.01).Conclusions: Opioid-related ADEs following surgery were associated with significantly increased LOS and hospitalization costs. These ADEs occurred more frequently in patients receiving higher doses of opioids.

Cerebral malaria is associated with decreased production of nitric oxide and decreased levels of its precursor, L-arginine. Abnormal amino acid metabolism may thus be an important factor in malaria pathogenesis. We sought to determine if other amino acid abnormalities are associated with disease severity in falciparum malaria. Subjects were enrolled in Dar es Salaam, Tanzania (children) (n = 126), and Papua, Indonesia (adults) (n = 156), in two separate studies. Plasma samples were collected from subjects with WHO-defined cerebral malaria (children), all forms of severe malaria (adults), and uncomplicated malaria (children and adults). Healthy children and adults without fever or illness served as controls. Plasma amino acids were measured using reverse-phase high-performance liquid chromatography with fluorescence detection. Several plasma amino acids were significantly lower in the clinical malaria groups than in healthy controls. Despite the differences, phenylalanine was the only amino acid with mean levels outside the normal range (40 to 84 µM) and was markedly elevated in children with cerebral malaria (median [95% confidence interval], 163 [134 to 193] µM; P < 0.0001) and adults with all forms of severe malaria (median [95% confidence interval], 129 [111 to 155] µM; P < 0.0001). In adults who survived severe malaria, phenylalanine levels returned to normal, with clinical improvement (P = 0.0002). Maintenance of plasma phenylalanine homeostasis is disrupted in severe malaria, leading to significant hyperphenylalaninemia. This is likely a result of an acquired abnormality in the function of the liver enzyme phenylalanine hydroxylase. Determination of the mechanism of this abnormality may contribute to the understanding of neurological complications in malaria.

BACKGROUND Many adverse drug events (ADEs) are the result of known pharmacologic properties, and some result from medication errors. However, some are the result of patient-specific risk factors.OBJECTIVE To identify inpatient risk factors for ADEs.METHODS Conditional logistic regression was used to analyze all pharmacist-verified ADEs by therapeutic class of drugs and severity during a 10-year study period. All inpatients ≥18 years of age from a 520-bed tertiary teaching hospital were included. Each case patient was matched with up to 16 control patients. Odds ratios for patient factors associated with ADEs were calculated from different therapeutic classes of drugs.RESULTS Odds ratios for numerous risk factors were identified for 4376 ADEs and were found to vary depending on therapeutic classification. The risk factors for the different classifications were grouped by (1) patient characteristics—female (OR 1.5–1.7), age (0.7–0.9), weight (1.2–1.4), creatinine clearance (0.8–4.7), and number of comorbidities (1.1–12.6); (2) drug administration—dosage (1.2–3.7), administration route (1.4–149.9), and number of concomitant drugs (1.2–2.4); and (3) patient type—service (1.2–4.9), nursing division (1.5–3.8), and diagnosis-related group (1.5–5.7).CONCLUSIONS Some risk factors are consistent for all ADEs and across multiple therapeutic classes of drugs, while others are class specific. High-risk agents should be closely monitored based on patient characteristics (gender, age, weight, creatinine clearance, number of comorbidities) and drug administration (dosage, administration route, number of concomitant drugs).

BACKGROUND: Pharmacy faculty manpower has been debated within the academic pharmacy community over the last several decades. Previous investigations studied job satisfaction among faculty members, but have not evaluated faculty retention and turnover among academic pharmacy departments.OBJECTIVE: To evaluate retention and turnover rates in the departments of Pharmacy Practice and Basic Science (Pharmacology/Toxicology, Pharmaceutics, Medicinal Chemistry) over the last 5 years.METHODS: Individual instructors and assistant, associate, and full professors across 80 colleges of pharmacy in the US were tracked between the years 1996 and 2001 using the American Association of Colleges of Pharmacy published rosters. Differences between departments were analyzed by year-stratified cross-tabulation table analysis.RESULTS: A greater percentage of Pharmacy Practice faculty resigned (10.6%) compared with Basic Science faculty (6.0%; percent ratio 1.76; 95% CI 1.58 to 1.95; p < 0.001), which remained constant across each academic year. Approximately 2.7 faculty members left their academic institutions per year in Pharmacy Practice compared with 1.1 faculty members in the aggregate of Basic Science departments. A higher percentage of women resigned in Pharmacy Practice (13.2%) than did men (8.7%; percent ratio 1.5; 95% CI 1.34 to 1.68; p < 0.001), despite a 1.3-fold male to female ratio. Likewise, regardless of a 4.1-fold male to female ratio in the Basic Science group, a higher percentage of women resigned (8.0%) than men (5.5%; percent ratio 1.45; 95% CI 1.18 to 1.78; p < 0.001).CONCLUSIONS: Over a 5-year period, Pharmacy Practice exhibited a higher turnover compared with Basic Science. Women displayed significantly higher turnover than men across all pharmacy academic departments. New retention approaches, especially for female faculty members, should be explored.

Adverse cardiac and pulmonary events are frequently observed during hemodialysis and contribute to significant morbidity and mortality. The temporal relationship between these events during the intradialytic period has not been well defined. To examine the event rate and timing of silent ischemia, cardiac ectopy, and hypoxemia, we conducted a prospective, single-blind, randomized study of 10 subjects undergoing maintenance hemodialysis with four contiguous combinations of dialysis membranes (cuprammonium or polysulfone) and dialysates (acetate or bicarbonate). The frequency of oxygen desaturation events peaked during the first 2 hours, whereas silent myocardial ischemia and supraventricular ectopies occurred more often in the later hours. Ventricular ectopy occurred steadily throughout the intradialytic period. The combination of acetate dialysis and cuprammonium membrane is associated with the most frequent events. We conclude that cardiopulmonary events can occur frequently during hemodialysis, and the frequency is dependent on the type of dialysis membrane and dialysate buffer used.

Angiotensin II enhances platelet aggregation through activation of the G protein-linked pathway present in platelets. Studies of several angiotensin-converting enzyme (ACE) inhibitors have demonstrated marked differences on platelets. Therefore this prospective, randomized, double-blind, crossover study compared the ex vivo effects of equivalent antihypertensive doses of captopril, enalapril, and fosinopril on platelet aggregation and thromboxane B2(TxB2) formation in subjects with stage I-II essential hypertension. Nineteen male subjects with a baseline mean seated blood pressure of 141 ± 3/100 ± 1 mm Hg were enrolled. The decline in mean arterial pressure after 4 weeks of stable dosing was 10 ± 1, 12 ± 1, and 11 ± 1 mm Hg for captopril, enalapril, and fosinopril, respectively (p = NS). There was no significant change in adenosine diphosphate (ADP)-, epinephrine-, or thrombin-stimulated platelet aggregation from baseline or between ACE inhibitors. Compared with baseline, fosinopril decreased TxB2concentrations 27.5-67.6% with all stimuli after 1 and 5 min. Captopril also decreased TxB2formation, but this effect was stimulus and time dependent. Enalapril consistently increased TxB2concentrations, independent of stimuli or time. We conclude that different ACE inhibitors have distinct effects on platelet TxB2formation without significant effects on platelet aggregation. Fosinopril may be a direct antagonist of TxA2synthase, suggesting benefit in syndromes of platelet activation or vascular occlusion.

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