Tumefactive Demyelinating Lesions in Children: A Rare Case of Conus Medullaris Involvement and Systematic Review of the Literature.

Tumefactive demyelinating lesions are an uncommon manifestation of demyelinating disease that mimic primary central nervous system neoplasms and can pose a diagnostic challenge in patients without a pre-existing diagnosis of multiple sclerosis. Although a biopsy may be required to distinguish TDL from neoplasms or infection, certain ancillary and radiographic findings may preclude the need for invasive diagnostic procedures. We describe the case of a 15-year-old boy with a tumefactive demyelinating lesion involving the conus medullaris.

Effects of Pharmacist-Conducted Medication Reconciliation at Discharge on 30-Day Readmission Rates of Patients With Chronic Obstructive Pulmonary Disease.

Purpose: To analyze effect of pharmacist-conducted medication reconciliation on 30-day readmission rates in chronic obstructive pulmonary disease (COPD) and identify common medication errors among patient with readmissions.

Methods: Pharmacists were educated on discharge medication reconciliation for patients with COPD. A retrospective chart review was conducted on patients who underwent pharmacist-conducted discharge medication reconciliation to determine 30-day readmissions.

Satisfaction With Medication Reconciliation Completed by Pharmacy Technicians in an Emergency Department.

Purpose: To survey advanced nurse practitioners, physician assistants, nurses, physicians, and resident physicians involved with collecting and reconciling medication histories in the emergency department (ED) to measure their satisfaction with the current process involving pharmacy technicians.

Methods: Two sites within a large health system with pharmacy technician-driven medication reconciliation processes asked health care professionals to complete a survey of 20 multiple-choice questions. The data collected determined resources used and barriers faced when collecting medication histories, satisfaction before and after the involvement of pharmacy technicians in the ED, and the impact technology may have on this process in the future.

Adverse effect profile comparison of pain regimens with and without intravenous acetaminophen in total hip and knee arthroplasty patients.

Background: The use of adjunct, non-opioid agents is integral for pain control following total hip and knee arthroplasty. Literature comparing safety profiles of intravenous acetaminophen versus opioids is lacking.

Objective: To determine whether there is a difference in frequency and type of adverse effects between intravenous acetaminophen-treated and non-intravenous acetaminophen-treated patients.

A Comparison of Medication Histories Obtained by a Pharmacy Technician Versus Nurses in the Emergency Department.

Purpose: To compare the medication history error rate of the emergency department (ED) pharmacy technician with that of nursing staff and to describe the workflow environment.

Methods: Fifty medication histories performed by an ED nurse followed by the pharmacy technician were evaluated for discrepancies (RN-PT group). A separate 50 medication histories performed by the pharmacy technician and observed with necessary intervention by the ED pharmacist were evaluated for discrepancies (PT-RPh group).

Adductor Canal Block With Bupivacaine Liposome Versus Ropivacaine Pain Ball for Pain Control in Total Knee Arthroplasty: A Retrospective Cohort Study.

Background: Appropriate postoperative pain control following total knee arthroplasty is important in patient recovery. Adductor canal block (ACB) is a novel method to deliver anesthesia. There are currently no studies using bupivacaine liposome with ACB while also taking into account cost.

Treatment of brodifacoum overdose with prothrombin complex concentrate.

Purpose: A case of brodifacoum overdose and its treatment with prothrombin complex concentrate (PCC) are reported.

Summary: A 44-year-old Caucasian woman weighing 62 kg arrived at the emergency department with a chief complaint of lower left leg pain for two days. A computed tomography (CT) scan of the abdomen revealed perihepatic fluid collection (likely a hematoma), a small-bowel intramural hematoma, and blood in the paracolic gutter.

Implications for multiple sclerosis in the era of the Affordable Care Act: the shifting managed care landscape.

Multiple sclerosis (MS) is a disorder of the central nervous system that is associated with disability, reduced quality of life, extensive medical and nonmedical costs, and lost productivity. Specialty medications that are crucial to effective disease management, helping to prevent debilitating episodes of relapse, account for a substantial portion of the medical expenditures associated with MS. Although these therapies are not considered cost-effective by conventional definitions, they are comparable to one another in cost-effectiveness estimates, leaving the complex task of designing cost-efficient formulary management strategies to managed care professionals.

Managed care implications of improving long-term outcomes in organ transplantation.

Refinements in solid organ transplantation techniques have resulted in improvements in patient and graft survival, and transplants are a cost-effective option for appropriate patients. Lack of improvement in graft survival, despite a reduction in acute rejection episodes, has sparked interest in both newer medications/treatment regimens and strategies to improve outcomes. Even as transplant professionals seek to optimize the therapeutic regimen for each patient, there are steps that managed care can take to further reduce costs and improve patient and graft survival.

Managed care aspects of managing multiple sclerosis.

Multiple sclerosis (MS) is associated with significant direct and indirect costs. Pharmacoeconomic studies of MS therapies have generally shown results which were not considered to be cost-effective when incremental cost-effectiveness ratios were analyzed for quality-adjusted life-years. When prevented relapses were considered as an end point, the cost-effectiveness results were generally more favorable, although the studies analyzed were limited by assumptions, projected outcomes, and lack of data on adverse events.

Economic burden and current managed care challenges associated with hepatitis C.

Infection with hepatitis C virus (HCV) is associated with significant morbidity, mortality, and economic burden. However, HCV infection is challenging to treat, because it is underdiagnosed and undertreated. When patients receive standard therapies, sustained virological response is usually achieved in less than 50% of cases.

Micronutrient-responsive cerebral dysfunction other than Wernicke's encephalopathy after malabsorptive surgery.

Background: Micronutrient-responsive cerebral dysfunction (MRCD) is known to occur after gastric restrictive and malabsorptive weight loss surgery. Wernicke's encephalopathy (WE) is often considered the etiology, but many cases without thiamine deficiency have been reported. It is important to recognize that other micronutrient-responsive cerebral dysfunctions exist in this high-risk group.

Comparison of two instruments for assessing risk of postoperative nausea and vomiting.

Purpose: Two instruments for assessing patients' risk of postoperative nausea and vomiting (PONV) were compared.

Methods: The existing protocol (protocol 1) assessed PONV risk using 16 weighted risk factors and was used for both adults and pediatric patients. The new protocol (protocol 2) included a form for adults and a pediatric-specific form.

Influenza vaccination among medical residents in a teaching hospital .

We assessed the rates of influenza vaccine acceptance and the reasons for acceptance or refusal among medical residents in different disciplines during the 2004-2005 influenza season. Rates varied among disciplines; emergency department residents had the lowest acceptance rate (24%). The perception of a low risk of contracting influenza was the most common reason reported for vaccine refusal.

Oral ganciclovir versus low-dose valganciclovir for prevention of cytomegalovirus disease in recipients of kidney and pancreas transplants.

Background: The optimal regimen for prophylaxis of cytomegalovirus (CMV) disease after kidney and/or pancreas transplantation remains unclear. We compared the effectiveness of three months of oral ganciclovir (3 g/day) versus low-dose valganciclovir (450 mg/day) for CMV prophylaxis.

Methods: We performed a retrospective cohort study of patients at our center who received kidney and/or pancreas transplants between January 2000 and April 2003.

The pharmacodynamic effects of sirolimus and sirolimus-calcineurin inhibitor combinations on macrophage scavenger and nuclear hormone receptors.

Background: Sirolimus (SIR) alone or in combination with cyclosporine (CsA) or tacrolimus (TAC) are used in solid organ transplantation, but uncertainty remains regarding their respective atherogenic potentials.

Methods: THP-1 cells were cultured as macrophages and then treated with plasma trough and peak concentration doses of SIR, SIR/CsA or SIR/TAC to assess the time- and dose-dependent mRNA or protein expression of selected atherogenic genes. The selected atherogenic genes included: the macrophage scavenger receptors (MSRs) CD36, CD68, scavenger receptor (SR)-A, SR-BII, and LOX-1; the nuclear hormone receptors peroxisome proliferator activated receptor gamma (PPARgamma) and liver-X-receptor alpha (LXRalpha); and the cholesterol efflux transporter (ABCA-1).

Percutaneous coronary intervention-related bleeding risk factors in current practice.

Background: Bleeding is a common and costly complication of percutaneous coronary intervention (PCI). Little is known about the risk factors for bleeding complications.

Objective: To report our PCI-related observations from a single institution and use the information to establish risk factors for short-term bleeding complications, with special focus on examining the importance of renal function.

Venous thromboembolism prevention in acutely ill nonsurgical patients.

Objective: To review recent advances in the prevention of venous thromboembolism (VTE) in acutely ill nonsurgical inpatients.

Data Sources: A MEDLINE search (1966-March 2005) was done to identify relevant articles relating to prevention of VTE in acutely ill nonsurgical inpatients.

Study Selection And Data Extraction: Four major prophylaxis trials, one registry, one guideline, and supporting articles representative of the subject matter from the last few years were included.

Effect of tacrolimus on the expression of macrophage scavenger and nuclear hormone receptors in THP-1-derived human macrophages.

Background: Data indicate that tacrolimus and cyclosporine A (CsA) differentially affect the risk of atherosclerosis. The results of our recent in vitro studies of clinically relevant CsA concentrations demonstrated the modulation of macrophage scavenger receptors (MSRs) involved in atherogenesis. This work evaluated the effects of clinically relevant tacrolimus concentrations on the expression of the MSR genes CD36 and CD68, SR-A and SR-BII, lectin-like oxidized low-density lipoprotein receptor-1, the nuclear hormone receptors peroxisome proliferator-activated receptor (PPAR)gamma and liver-X-receptor-alpha, and the cholesterol efflux pump ABCA1 in the in vitro human THP-1 macrophage model.

Insights into cyclosporine A-induced atherosclerotic risk in transplant recipients: macrophage scavenger receptor regulation.

Clinical monitoring of organ-transplant recipients suggests that administration of cyclosporine (CsA) may increase the risk of atherosclerosis when compared with the general population. The purpose of this work is to demonstrate the utility of the in vitro Tamm-Horsfall protein (THP)-1 human monocyte cell culture model for determining drug-related atherosclerotic potential in macrophages. The effect of CsA on the mRNA expression of macrophage scavenger receptor genes including CD36, CD68, scavenger receptor (SR)-A, SR-BII, and lectin-like oxidized low-density lipoprotein receptor (LOX-1); the nuclear hormone receptors, including peroxisome-proliferator activated receptor (PPAR)gamma and liver-X-receptor (LXR)alpha; and the cholesterol efflux pump ABCA1 were investigated as markers of atherosclerotic progression.

Drug-related dyslipidemia after renal transplantation.

Purpose: The frequency, onset, mechanisms, and causes of dyslipidemia after renal transplantation are reviewed in the context of the adverse impact of lipid alterations, recent guidelines, and the available treatment options.

Summary: At least 60% of adult renal transplant recipients develop dyslipidemia, which occurs within one month of the initiation of immunosuppressive therapy and continues indefinitely unless treated. Cyclosporine, sirolimus, and prednisone are mainly implicated, and the lipid profile differs between individual agents.