Patient care contributions of clinical pharmacists in four ambulatory care clinics

This study investigates both cost-avoidance and improvement in the quality of care and patient outcome attributed to pharmacist intervention in four ambulatory care clinics. Four clinical pharmacists reported 199 interventions made in the pharmacotherapeutic management of 87 ambulatory clinic patients in 1 month. The majority of interventions were based on acceptable professional practices as ranked by peer reviewers. Positive impact of the interventions on patient outcome based on objective and subjective data was documented in 49% of the interventions. Forty-two percent of the interventions improved the process of care with no measurable impact on patient outcome. Cost avoidance was calculated according to interventions made at different steps of the drug use process. Net cost avoidance figures projected to 1 year amounted to $221,056.     

Plasma catecholamines and oxygen consumption during weaning from mechanical ventilation

Previous studies on oxygen consumption ( ) during weaning from mechanical ventilation assumed that an increase in ( ) reflected oxygen consumption by respiratory muscles ( ), and proposed as a weaning predictor. We measured CO₂ production ( ) and plasma catecholamines in 20 short-term ventilated patients during weaning by SIMV and CPAP. as a percentage of during spontaneous ventilation ( %) ranged from 4.8% to 41.5%. also increased and correlated with . Plasma adrenaline and noradrenaline increased significantly to levels known to produce considerable increases in metabolic rate. Mean arterial pressure and heart rate concomitantly increased, but spontaneous minute ventilation decreased. Thus, since the increased plasma catecholamines are calorigenic, the assumption that represents is incorrect. Although mean % of successfully weaned patients was significantly less than that of failure-to-wean patients, the wide scatter of individual values in the latter group excludes % as an accurate weaning predictor.     

External fixation of the distal radius: to predrill or not to predrill

Using both clinical and laboratory studies we investigated whether predrilling before insertion of external fixation pins is necessary for use in treating distal radius fractures. Our clinical study included 50 consecutive external fixators (4.0- and 2.5-mm pins) using 100 predrilled and 100 direct-drilled pins placed in a randomized manner. There was no increased incidence of pin track infection or other pin problem with the direct-drilled technique. There were, however, significantly elevated temperatures with the direct-drilled technique. We therefore recommend predrilling even though the temperature differences in this bone with this fixator were not clinically evident.     

Deletion of 7p or monosomy 7 in pediatric acute lymphoblastic leukemia is an adverse prognostic factor: a report from the Children's Cancer Group.

Monosomy 7 or deletions of 7q are associated with many myeloid disorders; however, the significance of such abnormalities in childhood acute lymphoblastic leukemia (ALL) is unknown. Among 1880 children with ALL, 75 (4%) had losses involving chromosome 7, 16 (21%) with monosomy 7, 41 (55%) with losses of 7p (del(7p)), 16 (21%) with losses of 7q (del(7q)), and two (3%) with losses involving both arms. Patients with losses involving chromosome 7 were more likely to be > or =10 years old, National Cancer Institute (NCI) poor risk, and hypodiploid than patients lacking this abnormality. Patients with or without these abnormalities had similar early response to induction therapy. Event-free survival (EFS) and survival for patients with monosomy 7 (P<0.0001 and P=0.0007, respectively) or del(7p) (P<0.0001 and P=0.0001, respectively), but not of patients with del(7q), were significantly worse than those of patients lacking these abnormalities. The poorer EFS was maintained after adjustment for a Philadelphia (Ph) chromosome, NCI risk status, ploidy, or an abnormal 9p. However, the impact on survival was not maintained for monosomy 7 after adjustment for a Ph. These results indicate that the critical region of loss of chromosome 7 in pediatric ALL may be on the p-arm.