Therapeutic Drug Monitoring and Dose Adjustment of Posaconazole Oral Suspension in Adults With Acute Myeloid Leukemia.

Background: Prophylaxis with posaconazole, an extended-spectrum triazole antifungal, has been shown to increase overall survival in adults with acute myeloid leukemia receiving intensive remission induction chemotherapy. A paucity of data exists evaluating therapeutic drug monitoring and subsequent dose adjustment based on serum concentrations in humans.

Methods: An observational study was performed in 29 adult patients with acute myeloid leukemia who initially received posaconazole oral suspension 200 mg 3 times daily and required ≥1 dose adjustment because of steady-state posaconazole serum concentration <0.

Etiologic and therapeutic analysis in patients with hypokalemic nonperiodic paralysis.

Background: Hypokalemic nonperiodic paralysis represents a group of heterogeneous disorders with a large potassium (K(+)) deficit. Rapid diagnosis of curable causes with appropriate treatment is challenging to avoid the sequelae of hypokalemia. We prospectively analyzed the etiologies and therapeutic characteristics of hypokalemic nonperiodic paralysis.

Peripheral amiodarone-related phlebitis: an institutional nursing guideline to reduce patient harm.

Intravenous amiodarone is one of the most widely used antiarrythmics for the treatment of atrial fibrillation with rapid ventricular response. Peripheral amiodarone infusion, however, often causes pain during infusion and subsequent phlebitis.Data collection on a cardiac telemetry unit revealed a high rate of phlebitis.

Muscle atrophy in response to cytotoxic chemotherapy is dependent on intact glucocorticoid signaling in skeletal muscle.

Cancer cachexia is a syndrome of weight loss that results from the selective depletion of skeletal muscle mass and contributes significantly to cancer morbidity and mortality. The driver of skeletal muscle atrophy in cancer cachexia is systemic inflammation arising from both the cancer and cancer treatment. While the importance of tumor derived inflammation is well described, the mechanism by which cytotoxic chemotherapy contributes to cancer cachexia is relatively unexplored.

Calcium chloride in neonatal parenteral nutrition: compatibility studies using laser methodology.

Introduction: We have previously reported results of precipitation studies for neonatal parenteral nutrition solutions containing calcium chloride and sodium phosphate using visual methods to determine compatibility. The purpose of this study was to do further testing of compatibility for solutions containing calcium chloride using more sensitive methods.

Methods: Solutions of Trophamine (Braun Medical Inc, Irvine, CA) and Premasol (Baxter Pharmaceuticals, Deerfield, IL) were compounded with calcium chloride and potassium phosphate.

Vacuum-assisted vaginal delivery (VAVD)-basics for the risk manager.

The neonatal intensive care unit (NICU) manager calls you about a baby delivered last night now with brain trauma. She understands that it was a difficult delivery with a vacuum. There were "multiple pop-offs" and, after the baby was delivered, the NICU resuscitation team was called.

Nurses' perspective on approaches to limit flu-like symptoms during interferon therapy for multiple sclerosis.

Background: Several interferon beta (IFNβ) formulations are approved for first-line use as disease-modifying therapies to treat patients with multiple sclerosis (MS). Systemic post-injection reactions, often termed flu-like symptoms (FLS), occur in approximately half of all patients treated with IFNβs and can affect adherence to therapy. These symptoms, which include pyrexia, chills, malaise, myalgia, and headaches, usually resolve within 24 hours or persist intermittently following each injection.

The specialized role of the RN in the Program of All-inclusive Care for the Elderly (PACE) interdisciplinary care team.

There is an increasing volume of literature supporting the Program of All-inclusive Care for the Elderly (PACE) as an innovative model of health care delivery for frail seniors. Registered Nurses (RN) hold an essential position among the PACE interdisciplinary teams (IDT) which serve as the foundational practice approach to patient care. There are currently 97 PACE programs in 31 states.

Proposed definitions for epidemiologic and clinical studies of Mycobacterium avium complex pulmonary disease.

Background: Epidemiologic and clinical studies of Mycobacterium avium complex (MAC) pulmonary disease typically use strict ATS/IDSA definitions designed for decisions about treatment. Studies based on these criteria may exclude a substantial number of patients with true disease. We reviewed patients treated for MAC pulmonary disease at an academic medical center to propose revised definitions encompass the full spectrum of MAC pulmonary disease.

Safety and underwater birth-what every risk manager should know.

Underwater birthing has become a popular birth practice in some areas of the country. Although many of these deliveries occur in a home birth setting, the practice has also been implemented in hospitals and birthing centers. There is continued controversy about the risks and benefits of underwater birthing (as opposed to hydrotherapy during labor), and many risk managers are unaware of these potential risks and benefits.

Delayed umbilical cord clamping in premature neonates.

Objective: Delayed umbilical cord clamping is reported to increase neonatal blood volume. We estimated the clinical outcomes in premature neonates who had delayed umbilical cord clamping compared with a similar group who had early umbilical cord clamping.

Methods: This was a before-after investigation comparing early umbilical cord clamping with delayed umbilical cord clamping (45 seconds) in two groups of singleton neonates, very low birth weight (VLBW) (401-1,500 g) and low birth weight (LBW) (greater than 1,500 g but less than 35 weeks gestation).

Calcium chloride and sodium phosphate in neonatal parenteral nutrition containing TrophAmine: precipitation studies and aluminum content.

Objectives: The objectives were to determine concentrations of calcium chloride (CaCl) and sodium phosphate (NaPhos) that can be safely added to TrophAmine-based parenteral nutrition (PN) and to measure aluminum (Al) concentrations in PN solutions containing CaCl and NaPhos vs those containing calcium gluconate (CaGlu) and potassium phosphate (KPhos).

Methods: In study A, PN solutions containing varying amounts of TrophAmine, CaCl, and NaPhos were compounded and then evaluated visually for precipitation. In study B, Al concentrations were measured in PN solutions containing CaCl and NaPhos (S1), CaGlu and NaPhos (S2), or CaGlu and KPhos (S3).

Long-term outcomes of a chitosan hemostatic dressing in laparoscopic partial nephrectomy.

This study examined the long-term safety and effectiveness of a chitosan hemostatic dressing (CHD) in a porcine laparoscopic partial nephrectomy (LPN) model. Eighteen miniswine underwent treatment of using CHD or Surgicel(®) and Tisseel(®) (S/T) for renal parenchymal hemostasis after LPN. The animals were followed up for 6 and 12 months.

Clinical impact of a real-time PCR assay for rapid identification of staphylococcal bacteremia.

The purpose of this study was to evaluate the impact of real-time PCR reporting both on timely identification of clustered Gram-positive cocci (GPC) in blood cultures and on appropriate antibiotic treatment. This retrospective, interventional cohort study evaluated inpatients with blood cultures positive for GPC in the pre-PCR (15 January 2009 to 14 January 2010) and post-PCR (15 January 2010 to 14 January 2011) periods. Post-PCR implementation, laboratory services completed batched PCR; results other than methicillin-resistant Staphylococcus aureus (MRSA) were reported in the electronic medical record without additional interventions.

Mechanical property characterization of electrospun recombinant human tropoelastin for vascular graft biomaterials.

The development of vascular grafts has focused on finding a biomaterial that is non-thrombogenic, minimizes intimal hyperplasia, matches the mechanical properties of native vessels and allows for regeneration of arterial tissue. In this study, the structural and mechanical properties and the vascular cell compatibility of electrospun recombinant human tropoelastin (rTE) were evaluated as a potential vascular graft support matrix. Disuccinimidyl suberate (DSS) was used to cross-link electrospun rTE fibers to produce a polymeric recombinant tropoelastin (prTE) matrix that is stable in aqueous environments.

What happens when the patent ductus arteriosus is treated less aggressively in very low birth weight infants?

Objective: It remains unclear whether indomethacin (INDO) and/or surgical ligation (LIGATE) are necessary to improve outcomes in premature infants with a patent ductus arteriosus (PDA). We have adopted a conservative approach to PDA management that emphasizes waiting for spontaneous closure unless certain cardiorespiratory distress criteria are met.

Study Design: This was a before-after observational study in infants born 501 to 1,500 g in two distinct epochs.

The OB hospitalist and the risk manager: ready for prime time.

In 1996, Wachter and Goldman described a new model of care in which hospital-based physicians provided patients' inpatient care in lieu of the patient's primary physician.(1) They termed these physicians hospitalists. The hospitalist movement had taken hold, and by 1999, 65% of internists had hospitalists in their community and 28% reported using them for inpatient care.

A good walk spoiled: on the disappearance of golf as an active sport in America.

During the past 60 years, there has been a major transition in the way golf is played in America. Its potential as exercise largely has been negated by the increase in motorized golf cart usage to approximately two of every three rounds played in this country. Accidents in golf carts have increased rapidly, which, by making the sport more dangerous, will likely bring future regulations.

Structural and cellular characterization of electrospun recombinant human tropoelastin biomaterials.

An off-the-shelf vascular graft biomaterial for vascular bypass surgeries is an unmet clinical need. The vascular biomaterial must support cell growth, be non-thrombogenic, minimize intimal hyperplasia, match the structural properties of native vessels, and allow for regeneration of arterial tissue. Electrospun recombinant human tropoelastin (rTE) as a medial component of a vascular graft scaffold was investigated in this study by evaluating its structural properties, as well as its ability to support primary smooth muscle cell adhesion and growth.

Rectovaginal Staphylococcus aureus colonization: is it a neonatal threat?

We sought to determine the rate of Staphylococcus aureus rectovaginal colonization and positive newborn blood cultures. Routinely obtained group B streptococcus (GBS) rectovaginal specimens were cultured for S. aureus using standard microbiology procedures.