Intravenous cephamandole pharmacokinetics and intramuscular bioavailability in neonates

ABSTRACT. Cephamandole pharmacokinetics during the first week of life, in term neonates, have been defined. The results of these studies allow a dosage recommendation of 25 mg/kg 12 hourly intravenously or 8 hourly intramuscularly. Cephamandole when administered intramuscularly was shown to be bioavailable (80.9 ± 16.4%).     

Synovial Fluid Crystals

Synovial fluid was aspirated from the Joints of unselected groupsof patients suffering from rheumatoid arthritis (30), osteoarthritis(34), pyrophosphate arthropathy (25) and gout (six). Speciallyselected patients with osteoarthritis (10) and other miscellaneousforms of arthropathy (six) were also Included. Total and differentialcell counts were performed, and the fluids were examined bypolarized light microscopy and analytical electron microscopyto determine crystal content. fluids from patients with rheumatoid arthritis and gout hada higher total cell count, and greater proportion of polymorphonuclearcells. There was no difference in the cell content in patientswith osteoarthritis and chronic pyrophosphate arthropathy. Osteoarthriticfluids containing crystals did not have a significantly differentcell count from those without. Polarized light microscopy was confirmed as a good techniquefor differentiating urate from pyrophosphate crystals. However,pyrophosphate crystals varied greatly in appearance, and wereoccasionally too small to be visualized. Crystals thought tobe brushite, formed in some fluids after aspiration, causingconfusion on polarized light examinations, and other unidentifiedbirefringent material was often seen. Analytical and scanning electron microscopy revealed a widevariation in the morphology and elemental content of synovialfluid crystals. Hydroxyapatite crystals were identified in nineout of 34 unselected osteoarthrltlc fluids, in 10 selected cases,and six with synovitis of unknown cause. Hydroxyapatite wasseen in combination with pyro phosphate in six cases, and wasthe only crystal identified in one case of ‘pyrophosphate’nrthropathy. Small pyrophosphate crystals, not seen with thelight microscope, were identified in two cases. Other crystallineparticles containing calcium and phosphorus were seen in somecases, but could not be identified. No crystals were identifiedin rheumatoid arthritis fluids. Crystal phagocytosis was visualizedusing scanning electron microscopy. It is concluded that hydroxyapatite crystals are commonly presentin synovial fluids in chronic arthritis, with or without pyrophosphate,and that a range of other calcium phosphate salts remain tobe identified.     

Pilot study of an innovative model for clinical education in dietetics

Aim:  To pilot and evaluate a new model of clinical dietetics education to address the sustainability of dietetic placements in the clinical setting.
Methods:  Final-year dietetics students (n = 14) completed all nine weeks of clinical placement in the pilot program at two large tertiary referral and teaching health services in metropolitan Melbourne. Staff and students completed surveys about their experience within a week of completing placement. Data collected included paid and unpaid staff working hours, hours in clinical and teaching activity, hours of student attendance and student clinical work hours. Data for the last month of the placement programs in the preceding three years were used for comparison with the pilot program.
Results:  Combined data for the two providers showed that the model reduced the amount of supervision hours per student hour on placement by 16% while maintaining quality indicators during the pilot compared with previous years. Students in the pilot program were more positive about their experience compared with students in the existing program. The overall trend of responses in the staff surveys was positive for the pilot program, but the trend was not as marked as that of student responses.
Conclusion:  The new model of clinical dietetics education was successfully piloted and demonstrated the potential to increase student training capacity without a negative impact on student achievement or major resource demands. Refinements to the model and opportunities to enhance integration into the dietetics degree program were identified during the project. The learning needs of non-English-speaking background students require further scrutiny.