Search

The shoulders with critical shoulder angle (CSA) of greater than 33-35° are associated with rotator cuff tears, whereas a CSA of less than 30° is likely to be osteoarthritic. However, anterior acromioplasty or lateral acromioplasty could not reduce high CSAs to the desired range (30-33°), with satisfactory accuracy and efficacy. Thus, we introduce a computer image-guided precise acromioplasty (CIG-PAP) technique, an individualized treatment based on three-dimensional planning. We believe that the introduction of this technique will provide an alternative approach to reduce a large CSA to the desired range (30-33°).

Duzhi Wan (DZW) has been extensively used in the prevention and treatment of ischemic stroke, but the mechanisms underlying its effects remain unclear. In this study, a combination of transcriptomics, metabolomics and network analysis was applied to identify the preventive mechanism of DZW in middle cerebral artery occlusion (MCAO)-induced ischemia/reperfusion (I/R) injury.The mice were divided into five groups: the sham group, I/R group, I/R + Ginaton group, I/R+DZW-L group, and I/R+DZW-H group. Neurological deficit scores and regional cerebral blood flow (rCBF), hematoxylin and eosin (HE) and Nissl staining results were evaluated. Transcriptomics analysis and metabolomics analysis were applied to identify the key genes and metabolites, and qRT-PCR, ELISA, and immunofluorescence were applied to verify the key targets.DZW significantly decreased the infarction size and neurological deficit scores, increased the rCBF percentage and neuronal number and improved neuronal morphology after MCAO. Transcriptomics and metabolomics analysis revealed that C3 and C5ar1 were core targets of DZW and indirectly regulated downstream purine metabolism, the pentose phosphate pathway, and glycerophospholipid metabolism-associated pathways via inflammatory cells. Moreover, ELISA, qRT-PCR, and immunofluorescence further confirmed that DZW significantly decreased the expression of C3, C5ar1, C5 and downstream inflammatory cytokines, including IL-6, IL-1β and MMP-9, at the gene and protein levels, suggesting that DZW decreased neuroinflammation and inhibited related metabolic pathways.C3 and C5 play important roles in the neuroprotective and antineuroinflammatory effects of DZW in protecting against cerebral I/R. This study provides novel insights into the neuroprotective effects of DZW and its clinical application.

Objectives Obtaining an accurate medication history upon admission to the hospital can be challenging and time-consuming. This study evaluated the efficacy of a medication reconciliation program, conducted by pharmacists, with the assistance of medication usage data from the Taiwan National Health Insurance (NHI). Characteristics of patients at high risk for drug discrepancies were also determined. Methods Patients admitted between May 2008 and September 2009 were recruited. The type and class of medication discrepancies reported by pharmacists, the medication discrepancy rate, physician acceptance rate, and time taken for the intervention were studied. The degree of harm that could have resulted from the discrepancies was independently evaluated by four pharmacists. The association between selected variables and the occurrence of drug discrepancies was analyzed. Results Among 3013 patients interviewed, the pharmacists identified 243 patients (8%) with at least one medication discrepancy between the patient's medication history and admission orders. There were 576 discrepancies identified. About 19% of the errors prevented could have potentially caused moderate to severe harm. The average time for one intervention was 18 ± 9.8 min. The number of preadmission medications, age, frequency of outpatient visits within 3 months prior to this hospital admission, and the number of specialist outpatient clinics the patient had visited within 3 months before the admission were determined to be risk factors for drug discrepancies. Conclusions This medication reconciliation program, conducted by pharmacists, was made more efficient by medication usage data from the Taiwan NHI. Pharmacists can reconcile medications more effectively by selecting patients at high risk for unintentional drug discrepancies.

Background The administration interval and dosage of the drugs must be adjusted properly according to patients’ renal functions to diminish adverse effects. The computerized monitoring system was established to modify drug dosing for patients with impaired renal function. The Renal Dosing Monitoring (RDM) system was officially operated in April 2007. Only one pharmacist was assigned to assess the reports and to offer the appropriate recommendations in the beginning of operation. The duties have been taken up by the individual pharmacist in each ward since January 2008. Purpose A retrospective analysis of the annual outcomes of applying the RDM system was conducted in March 2008. The goal of the study was to assess the outcome of the application of the RDM system. Method The computerized RDM system was established and applied for screening patients with renal dysfunction. Recommendations for frequency and dosage adjustments were made according to the renal function evaluated. Ranks of the drugs, physicians’ acceptance rates, and time to modify prescriptions were assessed by reviewing the documentation of pharmacy interventions. The savings of medication cost was also calculated. Results The physicians accepted 173 (86%) of the 202 recommendations provided by the pharmacists. Most of the recommendations were related to antibiotics, and gentamicin was the most frequently involved drug. The durations for the physicians to modify their prescriptions were as follows: 142 cases were accomplished within 0–1 day (82%), 26 cases were modified within 2–3 days (15%), and five cases were done after more than 3 days (3%). The total saving was US$5377. The physicians declined the pharmacists’ recommendations in 29 cases because of serious infectious conditions in 14 cases (48%), the advice of infection specialists was followed in six cases (21%), and the rest of the cases (31%) had other reasons, such as unwilling to change patients’ long-term medications. Conclusion The study showed that the RDM system could be an aid for pharmacists to evaluate the appropriateness and safety of medication more precisely and effectively.