The bioresorbable coronary scaffold

The routine placement of permanent metal stents has led to an improvement of the long-term and short-term effects of percutaneous coronary interventions. Treatment with the newest generation of drug-eluting stents results in a low risk of restenosis. The antiproliferative drug eluted by these stents, however, prevents endothelialisation; this leads to an increased risk of exposed metallic stent parts, which in turn leads to a higher risk of stent thrombosis. There is evidence that the vessel wall support provided by the stent is only a temporary requirement. Permanent metallic stents could, therefore, be superfluous in the long term. A bioresorbable vascular scaffold (BVS), manufactured from polylactic acid and completely resorbed within 18-24 months, is a new alternative. It is expected that these scaffolds will lead to the disappearance of the risk of late stent thrombosis. Theoretically, the bioresorbable vascular scaffold also provides a considerable advantage for patients who will probably have to undergo further coronary intervention in the future. Metal stents can be an important limiting factor for these patients.     

Provider barriers to hydroxyurea use in adults with sickle cell disease: a survey of the Sickle Cell Disease Adult Provider Network

The FDA approved hydroxyurea for use in adults with sickle cell disease (SCD) in 1998. In 2002, the NHLBI published recommendations for the use of hydroxyurea in this patient population. The purpose of this study was to evaluate providers' awareness of the NHLBI recommendations regarding hydroxyurea prescribing, whether these recommendations have changed providers' practices and how these providers prescribed hydroxyurea. We chose to survey a select group of providers of care to adults with SCD, members of the Sickle Cell Adult Provider Network. The response rate was 47%. Eighty-one percent of respondents reported they had read the NHLBI recommendations on hydroxyurea use, and 76% of respondents agreed with the NHLBI recommendations. Only 45% of respondents to this survey reported that they prescribe hydroxyurea to every eligible patient. Black respondents reported a higher percentage of their eligible patients being on hydroxyurea than white respondents. Seventy-seven percent of respondents thought that hydroxyurea was effective or very effective in patients with SCD. Ninety-four percent of black versus 73% of white versus 40% of other race respondents thought that hydroxyurea was effective or very effective in SCD patients (p = 0.006). The results of this survey suggest that lack of awareness, agreement and belief in the benefits of hydroxyurea contributes to providers underprescribing hydroxyurea.     

Pharmacists and their customers: a personal or anonymous service?

Aims — To explore the existence and nature of the pharmacist‐customer relationship. Methods — A qualitative approach was adopted. Semi‐structured interviews were conducted with 20 customers recruited from two pharmacies differing in type and location: Pharmacy A, a multiple chain pharmacy in a more affluent area, and pharmacy B, a small chain pharmacy. Key findings — Customers' views differed according to the pharmacy from which they were recruited. Pharmacy B customers had a personal relationship with the pharmacist and used the pharmacy as a health care resource, while pharmacy A customers did not have a personal relationship with the pharmacist and used the pharmacy simply for medicine supply. Several pharmacy A customers had their own different local pharmacist whom they used for more personal advice and counselling. Both groups described disadvantages of multiple chain pharmacies. Consumerist behaviour was identified among customers whereby they preferred to control the provision of advice, assess it and act upon it. However, lack of information was mentioned by several interviewees, which suggested that different types of customers have different needs from the pharmacy. The pharmacist has therefore to recognise these different needs and to meet them accordingly to provide services, whether anonymous or personal, within their “extended role.” While most customers viewed pharmacists as drug experts and considered managing minor ailments to be part of their job, they were less supportive of a more extended role in the therapeutic monitoring of drug therapy. This presents a serious barrier to pharmacists wishing to extend their role into a more patient‐oriented and clinical domain. Conclusion — This study reinforces the importance of considering customers' views when policies and strategies concerning the development of the “extended role” are considered. Recognising customers' views helps the profession to adapt and respond to changing consumer behaviour. Issues identified through this in‐depth exploration of public perceptions of pharmacists have implications for the extension of pharmacists' roles into areas favoured and appreciated by customers.     

Surgery in patients with hemoglobin SC disease

While surgery is commonly required for complications related to hemoglobin SC (HbSC) disease, little is known about the perioperative complications or the indications for preoperative transfusion in this group. We describe the patient characteristics, preoperative transfusion regimens, and outcome in 92 patients with HbSC and sickle-variants undergoing elective surgery. Thirty-eight percent of the patients were transfused preoperatively. Patients transfused were more likely to have been hospitalized in the year prior to the surgery and scheduled for abdominal procedures. Abdominal and ear, nose and throat procedures were the most common surgeries in our study. The overall complication rate was 18% and sickle cell-related complications occurred in 9% of patients. In patients undergoing intra-abdominal procedures, the incidence of sickle cell-related complications was significantly higher in those patients not transfused prior to their surgery (35 vs. 0%). There were two deaths. We recommend selective use of preoperative transfusion in patients with HbSC disease undergoing surgery. Transfusion appears to be beneficial in abdominal cases but is not necessary with minor procedures such as myringtomy. Am. J. Hematol. 57:101–108, 1998. © 1998 Wiley-Liss, Inc.