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American College of Clinical Pharmacy Haas CE Eckel S Arif S Beringer PM Blake EW Lardieri AB Lobo BL Mercer JM Moye P Orlando PL Wargo K 《Pharmacotherapy》2012,32(2):e35-e44
This commentary from the 2010 Task Force on Acute Care Practice Model of the American College of Clinical Pharmacy was developed to compare and contrast the "unit-based" and "service-based" orientation of the clinical pharmacist within an acute care pharmacy practice model and to offer an informed opinion concerning which should be preferred. The clinical pharmacy practice model must facilitate patient-centered care and therefore must position the pharmacist to be an active member of the interprofessional team focused on providing high-quality pharmaceutical care to the patient. Although both models may have advantages and disadvantages, the most important distinction pertains to the patient care role of the clinical pharmacist. The unit-based pharmacist is often in a position of reacting to an established order or decision and frequently is focused on task-oriented clinical services. By definition, the service-based clinical pharmacist functions as a member of the interprofessional team. As a team member, the pharmacist proactively contributes to the decision-making process and the development of patient-centered care plans. The service-based orientation of the pharmacist is consistent with both the practice vision embraced by ACCP and its definition of clinical pharmacy. The task force strongly recommends that institutions pursue a service-based pharmacy practice model to optimally deploy their clinical pharmacists. Those who elect to adopt this recommendation will face challenges in overcoming several resource, technologic, regulatory, and accreditation barriers. However, such challenges must be confronted if clinical pharmacists are to contribute fully to achieving optimal patient outcomes. 相似文献
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İbrahim Halil Kurt 《Surgery today》2009,39(5):381-386
Cardiac failure is among the most significant conditions associated with acute coronary syndrome. In ischemic heart disease,
serious hemodynamic problems are reported in patients with left ventricular dysfunction during the acute phase despite mechanical
revascularization. Several positive inotropic agents in addition to intra-aortic balloon pump (IABP) are required to support
patients with impaired left ventricular pump function during this phase. Intravenous inotropic agents, beta-mimetics, and
phosphodiesterase inhibitors lead to increases in the incidence of arrhythmia and myocardial O2 consumption owing to their effect of increasing intracellular calcium amount, although they produce rapid hemodynamic improvements
in cardiac failure. This causes severe problems particularly in cardiac failure of ischemic origin. Recently, levosimendan,
a calcium-sensitizing agent with cardioprotective properties, is being used alone or in combination with IABP in cases with
severe left ventricular systolic dysfunction during mechanical revascularization procedures (percutaneous coronary interventions,
coronary bypass surgery). This review includes studies with levosimendan in cases not recovering due to myocardial stunning
in the acute phase despite mechanical approaches applied. 相似文献
998.
Kurt P. Spindler Martha M. Murray James L. Carey David Zurakowski Braden C. Fleming 《Journal of orthopaedic research》2009,27(5):631-638
Many anterior cruciate ligament (ACL) reconstructions have increased laxity postoperatively. We hypothesized that enhancing an ACL graft with a collagen‐platelet composite (CPC) would improve knee laxity and graft structural properties. We also hypothesized the platelet concentration in the CPC would affect these parameters. Twelve goats underwent ACL reconstruction with autologous patellar tendon graft. In six goats, a collagen‐platelet composite was placed around the graft (CPC group). In the remaining six goats, the collagen scaffold only was used (COLL group). Three goats were excluded due to complications. After 6 weeks in vivo, anterior–posterior (AP) laxity and tensile properties of the ACL reconstructed knees were measured and normalized against the contralateral intact knee. At a knee flexion angle of 30°, the average increase in AP laxity was 40% less in the CPC group than the COLL group (p = 0.045). At 60°, the AP laxity was 30% less in the CPC group, a difference that was close to statistical significance (p = 0.080). No differences were found between treatment groups with respect to the structural properties (p > 0.30). However, there were significant correlations between serum platelet concentration and AP laxity (R2 = 0.643; p = 0.009), maximum load (R2 = 0.691; p = 0.006), and graft stiffness (R2 = 0.840; p < 0.001). In conclusion, use of a CPC to enhance healing of an allograft ACL reconstruction inversely correlated with early sagittal plane laxity and the systemic platelet count was highly predictive of ACL reconstruction graft strength and stiffness at 6 weeks. These findings emphasize the importance of further research on delineating the effect of platelets in treating of ACL injuries. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 631–638, 2009 相似文献
999.
Martha M. Murray Matthew Palmer Eduardo Abreu Kurt P. Spindler David Zurakowski Braden C. Fleming 《Journal of orthopaedic research》2009,27(5):639-645
In this study, we hypothesize that supplementation of suture repair of the anterior cruciate ligament (ACL) with platelet‐rich plasma (PRP) will improve the biomechanics of the repair. Six 30‐kg pigs underwent bilateral suture repair of the ACL. One side was treated with suture repair alone, while the contralateral side was treated with suture repair augmented with PRP. After 14 weeks in vivo, anterior–posterior (AP) knee laxity and the tensile properties of the repaired ligament were measured. The addition of PRP to the suture repairs did not improve AP knee laxity at 30° (p = 0.73) or 60° (p = 0.65). It also did not improve the maximum tensile load (p = 0.64) or linear stiffness (p = 0.42) of the ACL repairs after 14 weeks in vivo. The model had 80% power to detect a 30% improvement of biomechanical properties with PRP; thus, we are confident that a clinically meaningful effect as a result of adding PRP is unlikely. Use of PRP alone to supplement suture repair of the ACL is ineffective in this animal model. Published by Wiley Periodicals, Inc. J Orthop Res 27: 639–645, 2009 相似文献
1000.
H. C. Irkilata S. Basal A. Taslipinar A. Gur M. M. Piskin B. Kurt L. Tahmaz E. Bolu & M. Dayanc 《Andrologia》2009,41(6):387-391
Ovotesticular disorder of sex development (OTDSD) is a rare condition and defined as the presence of ovarian and testicular tissue in the same individual. Most of patients with OTDSD have female internal genital organs. In this report, we present a case in which, we demonstrated prostate tissue using endoscopic and radiologic methods in a 46-XX, sex determining region of the Y chromosome negative male phenotypic patient, with no female internal genitalia. Existence of prostate in an XX male without SRY is rarely seen and reveals a complete male phenotype. This finding is critical to figure out what happens in embryonal period. 相似文献