Endovascular stent graft treatment of acute thoracic aortic transections due to blunt force trauma.

Endovascular stent graft treatment of acute thoracic aortic transections is an encouraging minimally invasive alternative to open surgical repair. Between 2006 and 2008, 16 patients with acute thoracic aortic transections underwent evaluation at our institution. Seven patients who were treated with an endovascular stent graft were reviewed.

The pharmacology and therapeutic utility of bisphosphonates.

Bisphosphonates have clinical application in diseases associated with increased bone turnover that inhibit osteoclast-mediated bone resorption by direct and indirect actions on osteoblasts and macrophages. Bisphosphonates are the treatment of choice for Paget's disease of bone, in which they return to normal the increased rate of bone turnover and slow radiographic disease progression. The agents reduce hypercalcemia associated with malignancy, and may reduce bone pain and prevent radiographic progression of metastatic bone disease.

A model for developing longitudinal health records.

The future of population health management will focus on treatment of chronic diseases and avoidance of acute disorders for targeted populations. The key tools for managing population health must involve outcomes measurement and management, wellness/preventive programs, care management programs, and cost management. This can be achieved by the implementation of a computerized patient health record for longitudinal health information (lifetime) recording and management.

Dissolution of phenytoin precipitate with sodium bicarbonate in an occluded central venous access device.

Objective: To report a case of restored patency of a central venous access device occluded by precipitate of phenytoin sodium injection.

Case Summary: A patient experienced total occlusion of an implanted subcutaneous port caused by precipitation of phenytoin. Phenytoin sodium injection was mixed inadvertently with dextrose 5% in NaCl 0.

Initiating a drug blood level monitoring program through CQI.

A blood level monitoring program was developed at St. James Hospital and Health Centers--a 472-bed community hospital located in Chicago Heights, IL. The primary goal of the program was to improve patient care by ensuring that drug levels were within their target range for the condition being treated.

How to tie a drug therapy improvement program to physician credentialing.

The pharmacy staff and the management information system specialist at St. James Hospital and Health Centers, a 472-bed community medical center located in Chicago Heights, Illinois, developed a computer program for documenting the drug use patterns of physicians. This program was not only helpful in improving the appropriate use of medications within the institution, it was also tied to the prescriber credentialing process.

Phenytoin concentration elevation subsequent to ranitidine administration.

Objective: To report elevated phenytoin (PHT) plasma concentrations in a patient receiving ranitidine.

Case Summary: A patient treated with PHT and ranitidine experienced elevated PHT plasma concentrations that persisted several days after PHT was discontinued. The PHT plasma concentration declined rapidly after withdrawal of ranitidine.

Strategic planning for the management of biotechnologic products: development of a biotech committee.

Strategies and tactics for managing biotechnologic products are critical to cope with the increasing number and cost of such products. One strategy is to develop a biotech committee to formulate long-term goals for managing biotechnologic products and to evaluate controversial or extremely expensive new products and recommend their formulary status to the P & T Committee. Involvement of the P & T Committee is crucial to establish strict criteria and monitors to ensure the appropriate and cost-effective use of these products.

Nutrition management for individuals with noninsulin-dependent diabetes mellitus in the 1990s: a review by the Diabetes Care and Education dietetic practice group.

Noninsulin-dependent diabetes mellitus (NIDDM), or Type II diabetes, is characterized by two primary defects: insulin resistance and insulin secretion. The two major goals of management of NIDDM are to achieve near normal metabolic control and to prevent/delay the microvascular and macrovascular complications of diabetes. Nutrition, exercise, and, if necessary, medication are the three primary treatment modalities used in NIDDM.