A data-driven quality-score system for rating drug products and its implications for the health care industry.

The quality of drug products in the United States has been a matter of growing concern. Buyers and payers of pharmaceuticals have limited insight into measures of drug-product quality. Therefore, a quality-score system driven by data collection is proposed to differentiate between the qualities of drug products produced by different manufacturers.

Is P&T Ready to Add Rapid Cycle Analytics to Formulary?

The intent of this article is to evaluate a novel approach, using rapid cycle analytics and real world evidence, to optimize and improve the medication evaluation process to help the formulary decision making process, while reducing time for clinicians. The Pharmacy and Therapeutics (P&T) Committee within each health system is responsible for evaluating medication requests for formulary addition. Members of the pharmacy staff prepare the drug monograph or a medication use evaluation (MUE) and allocate precious clinical resources to review patient charts to assess efficacy and value.

COVID-19 pandemic preparedness: A practical guide from an operational pharmacy perspective.

Purpose: To describe our medical center's pharmacy services preparedness process and offer guidance to assist other institutions in preparing for surges of critically ill patients such as those experienced during the coronavirus disease 2019 (COVID-19) pandemic.

Summary: The leadership of a department of pharmacy at an urban medical center in the US epicenter of the COVID-19 pandemic proactively created a pharmacy action plan in anticipation of a surge in admissions of critically ill patients with COVID-19. It was essential to create guidance documents outlining workflow, provide comprehensive staff education, and repurpose non-intensive care unit (ICU)-trained clinical pharmacotherapy specialists to work in ICUs.

COVID-19 pandemic preparedness: A practical guide from clinical pharmacists' perspective.

Purpose: To describe our hospital pharmacy department's preparation for an influx of critically ill patients during the coronavirus disease 2019 (COVID-19) pandemic and offer guidance on clinical pharmacy services preparedness for similar crisis situations.

Summary: Personnel within the department of pharmacy at a medical center at the US epicenter of the COVID-19 pandemic proactively prepared a staffing and pharmacotherapeutic action plan in anticipation of an expected surge in admissions of critically ill patients with COVID-19 and expansion of acute care and intensive care unit (ICU) capacity. Guidance documents focusing on supportive care and pharmacotherapeutic treatment options were developed.

Medication utilization in patients in New York hospitals during the COVID-19 pandemic.

Purpose: Utilization of hydroxychloroquine, chloroquine, and supportive therapy drugs in hospitals in New York during the early weeks of the coronavirus disease 2019 (COVID-19) pandemic was analyzed.

Summary: Drug utilization trends for 7 medications used to treat patients with suspected or confirmed COVID-19 at 47 New York hospitals were identified. The data demonstrated sharp increases in aggregate utilization of hydroxychloroquine and chloroquine and the number of patients receiving either drug beginning on March 15, with a notable 20% median increase per day through March 31.

Multilayer Model of Pharmacy Participation in the Antimicrobial Stewardship Program at a Large Academic Medical Center.

Leveraging pharmacy personnel resources for the purpose of antimicrobial stewardship program (ASP) operations presents a challenging task. We describe our experience integrating all pharmacists into an ASP, and evaluate the impact on ASP interventions, antimicrobial utilization, rate of selected hospital-onset infections and readmission. During a study period (January 1 to December 31, 2015), a total of 14 552 ASP-related pharmacy interventions were performed (ASP clinical pharmacotherapy specialists [CPS] n = 4025; non-ASP CPS n = 4888; hospital pharmacists n = 5639).

Role of postgraduate year 2 pharmacy residents in providing weekend antimicrobial stewardship coverage in an academic medical center.

Purpose: The integration of pharmacy residents into an antimicrobial stewardship program (ASP) is described, and data on the residents' ASP interventions and outcomes are reported.

Summary: ASP coverage of nighttime, holiday, and weekend shifts is often provided by infectious diseases (ID) medical fellows and staff pharmacists, potentially leading to inconsistent stewardship practices. As part of an initiative by a large urban hospital to provide around-the-clock, comprehensive ASP services 7 days a week, postgraduate year 2 (PGY2) pharmacy residents in ID or critical care were assigned to provide ASP coverage on weekends.

Fracture resistance of teeth restored with direct and indirect composite restorations.

Objective: Tooth fracture is a common dental problem. By extension of cavity dimensions, the remaining tooth structure weakens and occlusal forces may cause tooth fracture. The aim of this study was to evaluate and compare the fracture resistance of teeth restored with direct and indirect composite restorations.

Improved endocardial border resolution during dobutamine stress echocardiography with intravenous sonicated dextrose albumin.

Objectives: The purpose of this study was to determine whether intravenous sonicated dextrose albumin could improve endocardial border resolution during dobutamine stress echocardiography.

Background: Sonicated albumin improves endocardial border resolution in patients undergoing exercise stress echocardiography. Because a sonicated mixture of albumin with dextrose results in better transpulmonary passage than sonicated albumin alone, this agent could be utilized to further improve endocardial border resolution during dobutamine stress echocardiography.

A monoclonal antibody to human insulin-like growth factor-I: characterization, use in radioimmunoassay and effect on the biological activities of the growth factor.

A monoclonal antibody (BPL-M23) to insulin-like growth factor-I (IGF-I) was obtained following immunization of BALB/c mice with human IGF-I conjugated to ovalbumin. The affinity constant of BPL-M23 for IGF-I was 10.5 litres/nmol and the cross-reactivities of IGF-II, multiplication-stimulating activity III-2 and insulin were 0.

[Acute changes in hematocrit: their effect on flows in the great arteries of newborns].

To study the effect of acute hematocrit changes on the central circulation of human neonates, pulsed Doppler echocardiography was performed to evaluate flow velocities in the main pulmonary artery (PA) and the ascending aorta (Ao) five and seven hours of age in 16 polycythemic neonates (mean hematocrit of 68.1%), and in 12 normal neonates (mean hematocrit of 57.1%).

[Pulsed Doppler echocardiographic detection of regurgitant blood flow in the ascending, descending and abdominal aorta of patients with aortic regurgitation].

To ascertain whether the presence of retrograde holo-diastolic flow (RHF) in the ascending, descending or abdominal aorta is indicative of the severity of aortic regurgitation (AR), ascending, descending and abdominal aortic flow velocities were measured by pulsed Doppler echocardiography in 35 patients with AR and in 18 patients without AR, confirmed by aortography. Among the 35 patients with AR, 15 had mitral regurgitation, 11 had mitral stenosis, eight had aortic stenosis, five had prosthetic mitral valves, four had prosthetic aortic valves and two had aorto-pulmonary shunts. Satisfactory flow velocity recordings were obtained from the ascending aorta of 47 patients (89%), from the descending aorta of 39 patients (74%) and from the abdominal aorta of 43 patients (81%).

Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography.

Pulsed Doppler echocardiography was used to examine the relation between pulmonary valve motion and pulmonary artery (PA) flow velocity patterns in 39 adults. In 16 patients with normal PA pressure (mean pressure less than 20 mm Hg), PA flow velocity accelerated slowly to a peak flow velocity at midsystole (time to peak flow velocity, or acceleration time = 134 +/- 20 ms [mean +/- standard deviation]), followed by a slow deceleration to the end of ejection, producing a "dome-like" appearance. In contrast, in 23 patients with elevated PA pressure (mean pressure 20 mm Hg or more), flow velocity accelerated rapidly to a peak flow velocity in early systole (acceleration time = 88 +/- 25 ms, p less than 0.

A pulsed Doppler echocardiographic study of the postnatal changes in pulmonary artery and ascending aortic flow in normal term newborn infants.

Postnatal circulatory adaptations were studied with Doppler echocardiographic measures of flow velocity in the main pulmonary artery (PA) and ascending aorta (Ao) in 45 normal full-term neonates at 5 hours and at 27 hours after birth. PA flow velocity integral (FVI) was measured as the area under the systolic flow velocity curve and reflected total systemic flow in the presence of a left-to-right shunt through the ductus arteriosus. This index increased from 5 and 27 hours age, while Ao FVI, reflecting total pulmonary flow, remained unchanged.

Effect of left ventricular size on early diastolic left ventricular filling in neonates and in adults.

Peak early diastolic left ventricular (LV) filling rate has been used as an index of LV diastolic function. However, it is known to be affected by LV size. Peak early diastolic transmitral flow velocity measured by pulsed Doppler echocardiography has also been proposed as a noninvasive method of assessing LV diastolic function.

Pulsed Doppler echocardiographic study of left ventricular filling in dilated cardiomyopathy.

Patients with dilated cardiomyopathy (DC) have been reported to have abnormal left ventricular (LV) diastolic properties. To evaluate LV diastolic filling characteristics in patients with DC, pulsed Doppler echocardiography was used to study mitral flow velocity in 21 patients with DC and mitral regurgitation (MR), 12 patients with DC but no MR and 19 age-matched normal subjects. Diagnosis of MR was based on the Doppler echocardiographic finding of holosystolic turbulent flow in the left atrium.

A simple Doppler echocardiographic method for estimating severity of aortic regurgitation.

Doppler echocardiography is useful for detecting aortic regurgitation (AR). To determine if the presence of retrograde holodiastolic flow in the abdominal aorta can be used to assess the severity of AR, abdominal aortic flow velocity was examined by pulsed Doppler echocardiography in 33 patients with AR and 10 patients without AR confirmed by aortography, and in 15 normal subjects. Among the 33 patients with AR, 15 had mitral regurgitation, 11 had mitral stenosis, 8 had aortic stenosis, 5 had prosthetic mitral valves, 4 had prosthetic aortic valves and 2 had aorticopulmonary shunts.

Effect of imaging view and sample volume location on evaluation of mitral flow velocity by pulsed Doppler echocardiography.

Pulsed Doppler mitral flow velocity measurements have been used to evaluate left ventricular diastolic filling. In normal persons these measurements are affected by age and respiration, but not by gender, body surface area or normal blood pressure. Additional factors that may influence these measurements include the imaging view and sample volume location.

Left ventricular filling in hypertrophic cardiomyopathy: a pulsed Doppler echocardiographic study.

Abnormal left ventricular diastolic properties have been described in patients with hypertrophic cardiomyopathy. To evaluate the diastolic filling characteristics of the left ventricle in patients with this disease, pulsed Doppler echocardiography was used to study mitral flow velocity in 17 patients with hypertrophic cardiomyopathy (11 with and 6 without systolic anterior motion of the mitral valve) and 16 age-matched normal subjects. There were no statistically significant differences between patients with hypertrophic cardiomyopathy with and without systolic anterior motion with regard to ventricular septal thickness, left ventricular posterior wall thickness, left ventricular internal dimensions or the extent of hypertrophy evaluated by two-dimensional echocardiography.