The pharmacokinetics of pyrimethamine in the rat: effect of mefloquine

The pharmacokinetics and tissue distribution of pyrimethamine have been determined in the rat. Following administration of pyrimethamine alone, drug concentrations declined biexponentially. By contrast, in the presence of mefloquine, the decline in pyrimethamine concentration more closely fitted a monoexponential pattern and the AUC0-6h for pyrimethamine was significantly reduced. Significantly more pyrimethamine was recovered from the livers but less from the lungs of the mefloquine-dosed rats compared with control. This study outlines a potentially clinically relevant drug interaction.     

Expectations and outcomes in organ transplantation.

Research is needed on the frequency of bad outcomes in transplantation. Allocation policies and professional or institutional self-interest may affect the incidence of bad outcomes, and the need for reform is stressed. Transplant recipients who have had a bad outcome often continue to receive aggressive care. The humanistic care of patients having bad outcomes requires attention to advance directives, discussion with patient and family of alternatives to aggressive treatment, and provision of an option for home hospice care. Finally, it must be reemphasized that the average typical good outcome is extraordinarily good, restoring function of a vital organ, extending and improving quality of life, and sometimes restoring near-normal health. In no way should the fact of bad outcomes reduce our commitment to producing good outcomes.     

The Scale of Emotional Arousability: bridging the gap between the neuroticism construct and its measurement

This paper outlines and evaluates a newly developed measure of neuroticism, the Scale of Emotional Arousability (SEA). The 15-item scale is economical to use, avoids the consistent pattern of negatively worded items that plagues the neuroticism (N) Scale of the Eysenck Personality Inventory (EPI) and comprises of items that focus specifically on emotional arousability, thereby bringing the measurement of neuroticism in line with Eysenck's (1967) original conceptualization. The SEA shows every indication of being psychometrically sound and correlates with related constructs in much the same way as the N Scale of the EPI. The SEA is recommended as an alternative to the EPI for research purposes, particularly where there is a need to measure independently such related constructs as neurosis, self-esteem and private self-consciousness.     

Attitudes toward the large-scale implementation of an incident reporting system.

OBJECTIVE: An electronic Incident Information Management System implemented system-wide by the Department of Health, New South Wales, Australia was evaluated. We hypothesized that health professionals (i) would support the system via utilization and favourable attitudes and (ii) that their usage and attitudes would vary according to profession with nurses being most, and doctors least, favourably disposed. DESIGN, SETTING AND PARTICIPANTS: An online, anonymous questionnaire survey of 2185 health practitioners. MAIN OUTCOME MEASURES: Undertaking system training, satisfaction with training, reporting incidents, incident reporting rates since system introduction and attitude questions focusing on use, security and evaluation of the system and workplace safety cultures. RESULTS: The first hypothesis received partial support. The majority of respondents had undertaken training and rated it highly. Most had reported incidents and maintained their previous reporting levels. Most attitudes regarding using the system and its security were favourable. Mixed attitudes were held about workplace safety cultures and the value of the system. Deficiencies in quality of reporting, feedback on incident reports and resources to analyse incident data were problems identified. The second hypothesis was confirmed. Nurses were most, and doctors least, likely to undertake training, report incidents and express favourable attitudes. Allied health responses were intermediate to those of the other professions. CONCLUSIONS: The system implementation was relatively successful, but more so with some professions. Problems identified indicated that expectations as to the goals achievable in the short term were optimistic, but these are amenable to planned interventions.     

Teaching children about their internal bodies

Children's knowledge about their internal bodies is related to their developmental age and the manner in which they are taught. Nurses need to consider appropriate methods, language, and timing for teaching basic anatomy and physiology to early school-age children to increase its effectiveness.     

Managing hyperglycemia in hospitalized patients

Insulin infusion is used in the critical care setting for prevention of hyperglycemia and is administered most safely under a structured, dynamic, dose-defining algorithm. The ordering of basal-prandial-correction SC insulin therapy, appropriate for most hospitalized patients who are eating, is simplified and standardized to excellence by the development of institutional order sets or computerized order entry templates. Basal insulin therapy is prescribed as intermediate-acting insulin or long-acting insulin analogue. Prandial insulin therapy is delivered with meals to prevent excessive glycemic excursions from occurring after ingestion of meals and is prescribed as rapid-acting insulin analogue. Correction-dose insulin therapy is ordered as small doses of rapid-acting insulin analogue delivered to correct hyperglycemia and is prescribed with appropriate timing so as to avoid stacking with previously administered doses of rapid-acting insulin analogue. Patients knowledgeable in diabetes self-management will experience satisfaction under an institutional policy that allows self-management to continue under appropriate conditions during hospitalization. To craft appropriate institutional tools for patient care, the input and consensus of a multidisciplinary group of health care professionals, including primary care providers and hospitalists, as well as specialists in diabetes with backgrounds in endocrinology, nutrition and dietetics, nursing, pharmacy, laboratory sciences, and quality assurance, is required.