Association between health system specialty pharmacy use and health care costs among national sample of Medicare Advantage beneficiaries.

Health care expenditures are growing rapidly. There is a growing body of literature showing that health system specialty pharmacy is associated with improvement in clinical outcomes; however, there is a lack of data on its effect on health care costs and utilization. To perform exploratory research assessing the association between health system specialty pharmacy use and health care costs and utilization.

Association of Use of an Integrated Specialty Pharmacy With Total Medical Expenditures Among Members of an Accountable Care Organization.

This cohort study examines the association of integrated specialty pharmacy use among members of a university hospital accountable care organization (ACO) with total medical expenditure.

Secondary immune thrombocytopenia (ITP) as an initial presentation of Whipple's disease.

Immune thrombocytopenia (ITP) is a heterogeneous autoimmune disease characterized by low platelet count that has been associated with a number of chronic infections but rarely described as a manifestation of Whipple's disease (WD). We present a case of Whipple's disease in a patient initially diagnosed with ITP. A 46-year old male in the fifth decade of life presented with presumed idiopathic ITP and was treated with several therapies including corticosteroids, rituximab, and thrombopoietin receptor agonists.

Clinical Practice Guideline: Safe Medication Use in the ICU.

Objective: To provide ICU clinicians with evidence-based guidance on safe medication use practices for the critically ill.

Data Sources: PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and ISI Web of Science for relevant material to December 2015.

Study Selection: Based on three key components: 1) environment and patients, 2) the medication use process, and 3) the patient safety surveillance system.

The Impact of Liver and Renal Dysfunction on the Pharmacokinetics and Pharmacodynamics of Sedative and Analgesic Drugs in Critically Ill Adult Patients.

The use of sedative and analgesic drug therapy is often necessary for the care of critically ill patients. Renal and hepatic dysfunction, which occurs frequently in this patient population, can significantly alter drugs' pharmacokinetic and pharmacodynamics properties. By anticipating how these medications may be affected by liver or kidney dysfunction, health care practitioners may be able to provide tailored dosing regimens that ensure optimal comfort while minimizing the risk of adverse events.

Utilization of buffered vinegar to increase the shelf life of chicken retail cuts packaged in carbon dioxide.

Poultry processors commonly place whole parts of broilers in plastic packages and seal them in an atmosphere of 100% carbon dioxide before shipping them to food service and retail customers. This practice extends the shelf life of retail cuts to approximately 12 d under refrigerated conditions. The objective of this study was to determine the antimicrobial efficacy of vinegar for growth inhibition of mesophilic and lactic acid bacterial counts and enhancement of shelf life in CO2-packaged refrigerated chicken thigh samples.

Introduction to drug pharmacokinetics in the critically ill patient.

Despite regular use of drugs for critically ill patients, overall data are limited regarding the impact of critical illness on pharmacokinetics (PK). Designing safe and effective drug regimens for patients with critical illness requires an understanding of PK. This article reviews general principles of PK, including absorption, distribution, metabolism, and elimination, and how critical illness can influence these parameters.

Potassium acetate and potassium lactate enhance the microbiological and physical properties of marinated catfish fillets.

Sodium or potassium salts such as lactate and acetate can be used to inhibit the growth of spoilage bacteria and food-borne pathogens, and thereby prolong the shelf-life of refrigerated seafood. However, minimal information is available regarding the combined effects of potassium salts (acetate and lactate) with an agglomerated phosphate blend on the quality and safety of refrigerated catfish fillets. The objective of this study was to determine the microbiological and quality characteristics of marinated catfish fillets treated with organic acid salts.

Pilot comparison of three cardiopulmonary resuscitation medication dosing strategies in overweight children.

Objectives: Dose calculations using three variations of patient weight estimates (actual body weight [ABW], ideal body weight [IBW], and the Broselow Pediatric Emergency Tape [BPET, a length-based weight estimation tool]) were compared to administered doses of cardiopulmonary resuscitation medications in overweight and obese children to assess for differences in dose.

Methods: This retrospective cohort analysis included 54 consecutive pediatric patients who underwent emergency resuscitation at UMass Memorial Medical Center between January 2000 and October 2008. Patients were identified using ICD-9 codes related to cardiopulmonary resuscitation.

Drug dosing considerations for the critically ill patient with liver disease.

Hepatic dysfunction in the critically ill patient presents a unique challenge to clinicians when designing pharmacotherapeutic treatment plans. Overall, the literature regarding drug dosing in critically ill patients with hepatic dysfunction is incomplete and current tools available to bedside clinicians have limitations. Despite these challenges, rational drug regimens can be implemented by critical care nurses who consider the potential impact of hepatic dysfunction on drug pharmacokinetics.

Pharmacist-conducted medication reconciliation in an emergency department.

Purpose: The effect of pharmacist conducted medication reconciliation on compliance with a hospital's medication reconciliation policy was studied.

Methods: In this eight-week pilot study, one pharmacist worked in the emergency department (ED) to facilitate the safe and accurate transfer of medication histories for admitted patients. During the first four weeks, retrospective chart review was performed for 100 patients in March 2006 to determine the compliance rate to the hospital's medication reconciliation policy (medication reconciliation completed for every patient using the hospital-approved form).

Effect of additive selection on calculated aluminum content of parenteral nutrient solutions.

Purpose: The quantity of aluminum in common ingredients used to compound parenteral nutrient (PN) solutions was calculated to quantify the actual aluminum content, and opportunities to modify the aluminum content by changing the manufacturer of the ingredients were explored.

Methods: A retrospective evaluation of a random sample of 10 neonatal, 10 pediatric, and 10 adult patients who received PN solutions was performed to quantify the aluminum content in these solutions on the basis of the ingredients used at the authors' institution. A recalculation was performed using the lowest aluminumcontaining ingredients to determine the potential for aluminum minimization in each PN solution.

The effects of liver and renal dysfunction on the pharmacokinetics of sedatives and analgesics in the critically ill patient.

In critically ill patients, the duration of effect and dose-response relationship of sedative and analgesic drugs can be significantly affected by the presence of renal or hepatic dysfunction. Alterations in pharmacokinetics and pharmacodynamics vary according to the degree of organ impairment and presence of comorbid illnesses. This article reviews the principals that govern the absorption, distribution, metabolism, and elimination of sedatives and analgesics during renal and hepatic impairment.

Management of delirium tremens.

Delirium tremens is recognized as a potentially fatal and debilitating complication of ethanol withdrawal. Research thus far has primarily focused on the prevention of delirium tremens.

Antifactor Xa levels in four patients with burn injuries who received enoxaparin to prevent venous thromboembolism.

Four patients with severe burn injuries received enoxaparin 40 mg twice/day subcutaneously for the prophylaxis of venous thromboembolism (VTE). Peak antifactor Xa levels were measured 4 hours after administration of a dose, and trough antifactor Xa levels were measured 30 minutes before the next scheduled dose. Ultrasonography was performed once/week to assess the presence of VTE.