Pharmacist-managed drug therapy helps meet requirements for drug-use evaluation.

Pharmacist-managed drug therapy at a 205-bed nonprofit, general medical and surgical hospital is described. The pharmacy department provides a drug therapy management service in which clinical pharmacists initiate and adjust drug therapy and order laboratory tests according to criterion-based protocols. A physician requests initiation of the protocol and cosigns all orders written by pharmacists. The protocols for pharmacy-managed drug therapy are developed primarily by the clinical pharmacists and approved by the hospital's pharmacy and therapeutics and executive committees. They delineate specific indicators of the process (e.g., timely initiation of therapy) and outcome (e.g., clinical efficacy) of drug therapy management. These indicators are included in the record kept by the pharmacist for each patient treated in this program, and this documentation is reviewed daily. The same documentation is used in the drug-use evaluation (DUE) process. (Drugs for which drug therapy management protocols have been developed are among those selected for DUE.) In 1990, pharmacists managed 3616 courses of drug therapy by using approximately 100 drug protocols. The criterion-based drug therapy management service helps to fulfill the hospital's drug-use evaluation responsibilities by establishing specific process and outcome indicators, proposing drugs for DUE inclusion, and collecting data.     

NKG2D defines tumor-reacting effector CD8+ T cells within tumor microenvironment

For successful immunotherapy for cancer, it is important to understand the immunological status of tumor antigen-specific CD8⁺ T cells in the tumor microenvironment during tumor progression. In this study, we monitored the behavior of B16OVA-Luc cells in mice immunized with a model tumor antigen ovalbumin (OVA). Using bioluminescence imaging, we identified the time series of OVA-specific CD8⁺ T-cell responses during tumor progression: initial progression, immune control, and the escape phase. As a result of analyzing the status of tumor antigen-specific CD8⁺ cells in those 3 different phases, we found that the expression of NKG2D defines tumor-reacting effector CD8⁺ T cells. NKG2D may control the fate and TOX expression of tumor-reacting CD8⁺ T cells, considering that NKG2D blockade in OVA-vaccinated mice delayed the growth of the B16OVA-Luc2 tumor and increased the presence of tumor-infiltrating OVA-specific CD8⁺ T cells.     

Cinoxacin. A review of its pharmacological properties and therapeutic efficacy in the treatment of urinary tract infections

Cinoxacin is a urinary antibacterial drug closely related structurally to nalidixic acid. It has a spectrum of in vitro antibacterial activity which qualitatively resembles that of the latter agent, covering most common Gram-negative pathogens, excluding Pseudomonas. In acute or recurrent urinary tract infections it has been shown to be at least as effective as nalidixic acid or co-trimoxazole, and in a few studies was as effective as amoxycillin or nitrofurantoin. Cinoxacin appears to be well tolerated and may have a low propensity to induce bacterial resistance during clinical use, although the latter needs further confirmation. Thus, cinoxacin is an effective alternative for treating urinary tract infections due to common Gram-negative pathogens, and its apparently low incidence of adverse effects may offer worthwhile advantages over the related compounds nalidixic and oxolinic acids. Its use as prophylactic therapy in patients with recurrent urinary tract infections is not yet well established, although this appears a worthwhile area for further study.     

Initial dentin formation in human deciduous teeth

Dentin matrix formation is initiated as far as 11 deep in the prospective dental pulp. From this area, growth of the preodontoblast processes occurs toward the ameloblast. Process elongation is followed successively by 3 stages of dentin matrix formation: 1) fibril formation, 2) matrix maturation and 3) matrix calcification. These stages occur concurrently with differentiation of the odontoblasts. The bases of the odontoblast processes and distal surfaces of their cell bodies extrude cytoplasmic buds into the surrounding matrix. These function as initial sites of calcification.This study was supported by PHS Research Grant HD-01842-04, National Institute of Child Health and Human Development.     

Femoral nerve block for total knee arthroplasty patients: a method to control postoperative pain

This study was designed to determine the effects of a single-injection femoral nerve block (FNB) using 30 mL of 0.5% bupivacaine with epinephrine 1:200,000, on pain control following total knee arthroplasty (TKA). Forty patients were randomly distributed into 2 groups: Group A received general anesthesia plus a FNB (n = 19), whereas Group B received general anesthesia plus a FNB with 30 mL of preservative-free saline (n = 21). The amount of morphine used, sedation, and average pain perception were measured for the first 24 hours and daily postoperatively. Group A used significantly less morphine (48.1 mg) compared with Group B, which used 76.2 mg during the first 24 hours after surgery (P = 0.003). Group A's sedation scale was significantly less than group B's (2.26 vs 2.67) (P = 0.045). The average pain perception was significantly different (P =.002). Postoperative management of pain following TKA can be improved through a preoperative single-injection FNB with 0.5% bupivacaine plus epinephrine 1:200,000. The cost is minimal, risks appear acceptable, and the procedure is efficacious.     

Influence of blood temperature on vascular stability during hemodialysis and isolated ultrafiltration

We tested the hypothesis that differing temperature (T) changes in extracorporeal blood circuit might partly account for the difference in vascular stability (VS) between isolated ultrafiltration (UF) and simultaneous UF-hemodialysis (HD). The study was carried out in 6 patients who presented frequent episodes of symptomatic hypotension during the routine dialytic sessions. During simultaneous UF-HD with dialysate T set at 37.5 degrees C (standard HD), blood reentered the patients with a T of about 2 degrees C higher, whereas during isolated UF (standard UF) 2 degrees C lower, than at its exit. These extracorporeal blood T changes were reciprocated by warming the venous line in isolated UF (warm UF) and by setting the dialysate at 34.5 degrees C in simultaneous UF-HD (cold HD). During warm UF mean arterial pressure (MAP) fell and heart rate (HR) increased nearly as much as during standard HD. Vice versa, during cold HD MAP and HR remained nearly as stable as during standard UF. It is concluded that the T changes in blood flowing through the extracorporeal circuit largely account for the differing VS between isolated UF and simultaneous UF-HD.