24-hour unit dose dispensing of class III-V controlled substances

Methods of controlling controlled substance (CS) inventories in unit dose dispensing systems vary. The two extremes are total floor stock of all CS drugs by the use of declining inventory signout sheets on the nursing unit to controlling only Class II and a few selected class III-V items. The method described herein outlines a systematic approach to controlling items on an individual patient basis consistant with the benefits of unit dose dispensing. A CS card assigned to each patient for each of his required controlled substance medications serves as an audit trail for doses consumed by the patient and provides a declining inventory receipt when returned to the pharmacy.     

Clinical studies of a fast homoarginine-sensitive alkaline phosphatase in patients with cancer

The activity of an isoenzyme of alkaline phosphatase (FHAP) was measured in serum samples obtained from 1692 individual subjects. The median FHAP concentration in patients with untreated or recurrent cancer (2.73 IU/liter) was two-fold higher than in hospitalized control patients with illnesses other than cancer (1.17 IU/liter) and three-fold higher than in healthy control subjects (0.93 IU/liter). Among patients with either breast or colorectal cancer who were clinically disease free following their initial therapy, the median FHAP concentration (1.54 IU/liter) was intermediate between the median FHAP concentration in patients with untreated or recurrent cancer and that of healthy control subjects. In order to illustrate the potential clinical application of FHAP as a diagnostic cancer marker, we have selected a serum FHAP concentration of 2.22 IU/liter as a reference value above which only 3% of healthy control subjects would have a "positive" test. Utilizing this reference value, 58% of the patients in the present study with untreated or recurrent cancer would have a positive FHAP test, whereas only 11%, of hospitalized patients with illnesses other than cancer would have a positive test. These data suggest that FHAP may be equivalent to the carcinoembryonic antigen as a diagnostic cancer marker.     

Professionalism: rise and fall.

Historically, the early professionalization movements in medicine and the law appear as organizational projects which aspire to monopolize income and opportunities in markets of services or labor and to monopolize status and work privileges in occupational hierarchies. Their central task is to standardize training and link it to actual or potential markets of labor or services, a linkage that is structurally effected in the modern university. The second wave of professionalization has different protagonists than the older "market professions": placed in a different structural situation, the bureaucratic professions transform the model of profession (which they adopt as a strategy of collective ascension) into an ideology. The import of the ideology of professionalism is examined in relation to two issues: the relationships between professional occupations and bureaucratic organizations; and the position of professional occupations within the larger structure of inequality. Analysis of the first point requires consideration of the distinctions between professional occupations in the public and private sectors, the use of professional knowledge and the image of profession in bureaucratic organizations, and the specific characteristics of professions that produce their own knowledge. In the discussion of the second point, professional occupations and their ideology are examined in relation to other occupations and to the possibilities of political awareness generated by uncertain professional statuses.     

Cell-kill modeling of microwave thermotherapy for treatment of benign prostatic hyperplasia

PURPOSE: We investigated whether cell-kill modelling could be used as a mean for predicting the outcome of microwave thermotherapy for benign prostate hyperplasia (BPH). METHODS: The two models--Henriques' damage integral and Jung's compartment model--were implemented in a computer program. Real treatment data for 22 patients with BPH who were in chronic retention were used as input, including measured intraprostatic temperatures and microwave power. To test if modelling gives results that are consistent with actual observations, comparison with transrectal ultrasound (TRUS) measurements of the prostate volume before and after treatment was made. The sensitivity of the computer model for variations in the heat cytotoxicity and the temperature probe location in the adenoma was also tested. RESULTS: The average TRUS volume reduction 3 months after treatment was 26 cc, whereas the corresponding cell kill calculation was 27 cc. The computer model appears to be rather insensitive to minor uncertainties in heat sensitivity and location of the intraprostatic reference temperature sensors. CONCLUSION: Cell-kill modelling appears to give results that are consistent with actual observations. The coagulated tissue volume is calculated in real time during the treatment, thereby providing an immediate prediction of the treatment outcome. By using cell-kill modelling, the endpoint of a treatment can be set individually; e.g., when a certain volume reduction has been achieved.     

Clinical results of microwave thermotherapy for benign prostatic hyperplasia

Transurethral microwave thermotherapy is a truly office procedure without the need for anesthesia for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia. Several devices have been developed. Continuous refinement of the procedure led to higher energy protocols and high-intensity dose protocols applying the heat-shock strategy. We report on the clinical results of these protocols. Symptom scores improve around 60%, whereas maximum urinary flow rate improve from an average 9 to 10 mL/sec at baseline to 14 to 15 mL/sec during follow-up. No significant differences have been shown between the outcomes with the different devices. Long-term data show satisfactory results after 4 years. Initial clinical results with the heat-shock strategy show results comparable to those of higher-energy protocols with decreased morbidity. Treatment morbidity of higher energy protocols is moderate and consists mainly of the need for catheterization and a higher percentage of retrograde ejaculation. To improve treatment efficacy, patient selection appears to be most important. Prostate size, bladder outlet obstruction, age, and prostate composition are of predictive value for treatment outcome. Further development of the treatment protocols and refinement of the urethral applicators might enhance outcome.     

Treatment of relapsed chronic lymphocytic leukemia by 72-hour continuous infusion or 1-hour bolus infusion of flavopiridol: results from Cancer and Leukemia Group B study 19805.

PURPOSE: Flavopiridol has in vitro activity in chronic lymphocytic leukemia (CLL) and promotes apoptosis independent of p53 function or prior fludarabine exposure. We sought to determine if flavopiridol has activity in previously treated CLL using two schedules of administration. PATIENTS AND METHODS: Patients with previously treated CLL were enrolled in two sequentially done phase II studies. Patients in the first trial received flavopiridol (50 mg/m(2)/d) as a continuous infusion (CI) for 72 hours every 2 weeks. Patients in the second trial received flavopiridol 50 mg/m(2) as a 1-hour bolus (IVB) daily for 3 days repeated every 3 weeks. Patients received up to 12 (CI cohort) or 8 (IVB cohort) cycles of therapy. RESULTS: Fifteen patients were enrolled in the 72-hour CI phase II trial; 6 (40%) had intermediate-risk (Rai stage I or II) and 9 (60%) had high-risk (Rai stage III and IV) stages. No responses were noted in this group; 27% had stable disease and 73% had progressive disease. Thirty-six patients were enrolled in the second IVB trial, with 13 (36%) having intermediate and 23 (64%) having high-risk disease. Four patients (11%) had partial responses, 19 (53%) had stable disease, and 13 (36%) had progressive disease. The progression-free survival for responders in the IVB trial was 3, 3, 9, and 19 months. The median progression-free survival was 2 months [95% confidence interval (95% CI), 1.8-3.8] for patients in the CI trial and 3 months (95% CI, 2.5-7.4) for the IVB trial. The median overall survival was 27 months (95% CI, 20-42) for the CI trial and 24 months (95% CI, 18-31) for the IVB trial. Toxicity was manageable and included mainly myelosuppression, infections, diarrhea, and fatigue. CONCLUSIONS: Flavopiridol has modest, schedule-dependent clinical activity in relapsed CLL and warrants future investigation utilizing alternative schedules of administration.     

Infant brain imaging using magnetoencephalography: Challenges,solutions, and best practices

The excellent temporal resolution and advanced spatial resolution of magnetoencephalography (MEG) makes it an excellent tool to study the neural dynamics underlying cognitive processes in the developing brain. Nonetheless, a number of challenges exist when using MEG to image infant populations. There is a persistent belief that collecting MEG data with infants presents a number of limitations and challenges that are difficult to overcome. Due to this notion, many researchers either avoid conducting infant MEG research or believe that, in order to collect high‐quality data, they must impose limiting restrictions on the infant or the experimental paradigm. In this article, we discuss the various challenges unique to imaging awake infants and young children with MEG, and share general best‐practice guidelines and recommendations for data collection, acquisition, preprocessing, and analysis. The current article is focused on methodology that allows investigators to test the sensory, perceptual, and cognitive capacities of awake and moving infants. We believe that such methodology opens the pathway for using MEG to provide mechanistic explanations for the complex behavior observed in awake, sentient, and dynamically interacting infants, thus addressing core topics in developmental cognitive neuroscience.     

Preschool behavior disorders: their prevalence in relation to determinants

The occurrence of behavior disorders was investigated in a prospectively followed 3-year-old birth cohort. Of 1116 eligible children, the parents of 918 were successfully contacted. All agreed to complete a telephone interview and were mailed a Childhood Behavior Checklist (CBCL) standardized for 2- to 3-year-old children; 756 (82%) returned the CBCL. The prevalence of one or more of the deviant behavior syndromes identified by the CBCL was 11.1%. From a number of subject characteristics recorded throughout infancy, age-specific determinants for the occurrence of these deviant behaviors were identified. Characteristics most consistently associated with preschool psychopathology included the mother's ill health and lack of social support, the presence of chronic illness in the child, and the frequent use of hospital emergency services. These and other determinant (risk) indicators were entered into logistic regression (LR) models to derived adjusted relative risk estimates for the occurrence of a behavior disorder. The derived LR equations emphasize the important role of both the mother as well and the father and the health of the child.