High-fidelity simulation for advanced cardiac life support training.

OBJECTIVE. To determine whether a high-fidelity simulation technique compared with lecture would produce greater improvement in advanced cardiac life support (ACLS) knowledge, confidence, and overall satisfaction with the training method. DESIGN.

Mitochondria-specific nanocarriers for improving the proapoptotic activity of small molecules.

The efficiency and efficacy of drug action depends largely on how well an unaided drug molecule is able to reach its intracellular target or even its target inside organelles such as mitochondria. Subsequently, the specific delivery of a drug to its site of action inside cells will dramatically improve its action. Mitochondria play a key role in apoptosis, and several clinically used, as well as experimental, drugs are known to trigger apoptosis by interacting directly with the target site at or inside mitochondria.

An evaluation of the use of oral bisphosphonates and risk of esophageal cancer.

Objective: To evaluate the use of oral bisphosphonates and risk of esophageal cancer.

Data Sources: MEDLINE (1948-October 2011) was searched using the terms esophageal cancer, esophageal carcinoma, bisphosphonate, bisphosphonates, etidronate, pamidronate, alendronate, tiludronate, risedronate, zoledronic acid, and ibandronate. Citations from relevant publications were reviewed for additional information.

From serendipity to mitochondria-targeted nanocarriers.

This review illustrates how a random observation at the laboratory bench has helped pave the way towards the development of organelle-targeted pharmaceutical nanocarriers. A fortuitous discovery in the mid 1990s involving the self-assembly of a molecule, known to accumulate inside mitochondria, has lead to the development of subcellular nanocarriers suited for the selective delivery of biologically active molecules to mitochondria inside living mammalian cells. Applications for mitochondria-specific drug and DNA delivery are described, the current state-of-the-art of mitochondrial drug targeting technology is reviewed, and its future perspectives are discussed.

Elevated international normalized ratio associated with use of dronedarone and warfarin.

Objective: To describe a case of elevated international normalized ratio (INR) after addition of dronedarone to warfarin therapy.

Case Summary: A 72-year-old white female with a history of tinnitus, gastroesophageal reflux disease, and permanent pacemaker implantation was taking warfarin (target INR 2-3) and sotalol for chronic atrial fibrillation; atorvastatin for hyperlipidemia; and risedronate for osteopenia. Her warfarin therapy had been managed by a nurse-run anticoagulation clinic for several years.

The effect of a computer-assisted insulin protocol on glycemic control in a surgical intensive care unit.

Background: Computer-assisted insulin protocols (CAIPs) contain complex mathematical algorithms to assist with insulin dosing. This study compared the quality of glucose control utilizing a CAIP with a paper-based insulin protocol (PBIP).

Methods: This before-after study identified consecutive patients who received continuous insulin therapy for at least 24 h.

Vitamin D and Alzheimer's disease: is there a link?

Objective: To review the research on a possible link between Alzheimer's disease (AD) and vitamin D deficiency.

Data Source: MEDLINE/PUBMED (January 1950-January 2010) and ISI Web of Science searches (January 1900-January 2010) were conducted using the key words vitamin D, Alzheimer disease, and dementia to identify pertinent studies. The Cochrane Library was searched to identify review articles along with clinicaltrials.

Implications of intracellular distribution of nanovesicles for bioimaging studies.

An ever increasing number of diverse nanomaterials for biopharmaceutical applications is emerging, ranging from liposomes, niosomes, micelles, nanoemulsions, dendrimers, nanocells, cell ghosts, lipoproteins to solid nanoparticles and quantum dots. Several of these nanomaterials have been brought from the bench into the clinic over the last three decades giving raise to "Nanomedicine", a term implying the application of nanotechnology for therapy and diagnosis. Though pharmaceutical nanoparticular carriers have been successfully established as devices for enhancing the therapeutic index of clinically approved and experimental drugs, their utilization for imaging and monitoring biological functions has just began to materialize.

Benzocaine-induced methemoglobinemia in two patients: interdisciplinary collaboration, management, and near misses.

Methemoglobin, a form of hemoglobin that does not bind oxygen, is produced when iron in red blood cells is oxidized from the ferrous state to the ferric state. Methemoglobinemia develops in the presence of oxidizing agents, such as benzocaine-containing topical anesthetic sprays, and it is characterized by cyanosis. If untreated, methemoglobinemia may prove lethal.

Ranolazine: a new approach to management of patients with angina.

Objective: To review the pharmacology, pharmacokinetics, and clinical efficacy of ranolazine for the treatment of chronic stable angina.

Data Sources: MEDLINE was searched (1966-February 2006) using the English-language key terms ranolazine and chronic stable angina. Additional studies were identified from the bibliographies of the reviewed literature.

Combination of clopidogrel and statins: a hypothetical interaction or therapeutic dilemma?

Background: The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) and clopidogrel are frequently used in the treatment of patients with various cardiovascular disorders. The possibility of a drug-drug interaction between certain statins and clopidogrel has been extensively investigated in the literature recently. Investigators have proposed that the use of statins that are metabolized by the cytochrome P450 (CYP) system may diminish the conversion of clopidogrel to its active form by inhibiting the CYP3A4 isoenzyme.

Frequency and management of thrombocytopenia with the glycoprotein IIb/IIIa receptor antagonists.

Glycoprotein IIb/IIIa receptor antagonists (GPRAs) are widely used in the management of a variety of patients with acute coronary syndromes. Major adverse reactions to these agents include bleeding and thrombocytopenia. Immune mechanisms responsible for severe thrombocytopenia seen with GPRAs have been hypothesized for all 3 agents currently available in the United States, although specific laboratory tests are not available for use in routine practice.

A protocol for the use of enoxaparin during pregnancy: results from 85 pregnancies including 13 multiple gestation pregnancies.

Many practitioners consider low-molecular-weight heparin (LMWH) an alternative to unfractionated heparin, although there are limited safety data regarding maternal and fetal outcomes in patients using an LMWH during pregnancy. A retrospective chart review was performed on 72 patients with thrombophilia exposed to the LMWH, enoxaparin, during pregnancy. Eighty-five pregnancies resulted in 93 of 99 potential live births.

Association between adherence to diuretic therapy and health care utilization in patients with heart failure.

Study Objective: To determine the relationship between adherence to diuretic therapy and health care utilization.

Design: Prospective, observational study.

Setting: University-affiliated medical center.

The pharmacist's role in self-care.

Self-care involves a variety of actions that patients take to manage their health. Pharmacists play an important role in guiding patient's self-care behaviors. Thorough assessment and effective communication are crucial to meaningful self-care counseling.

Importance of environmental context in the development of amphetamine- or apomorphine-induced stereotyped behavior after single and multiple doses.

The present study was designed to determine whether single and repeated pretreatment regimens with amphetamine or apomorphine differ in the context-dependency of sensitization of stereotyped behavior. Male CF-1 mice that were pretreated with a single high dose of amphetamine (14 mg/kg intraperitoneally [IP]) or apomorphine (40 mg/kg subcutaneously [SC]) only became sensitized to a lower test dose of amphetamine (7 mg/kg IP) or apomorphine (3 mg/kg SC) when placed in an environment that was the same as the pretreatment environment. However, animals pretreated with 3 high doses (24-h apart) of amphetamine (14 mg/kg IP) or apomorphine (40 mg/kg SC) did demonstrate sensitization to a lower test dose of amphetamine (7 mg/kg IP) or apomorphine (3 mg/kg SC) when placed in an environment that was different from the pretreatment environment.