Pharmacist's review and outcomes: Treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK)

PURPOSE

The purpose was to describe clinical pharmacist interventions across a range of critical care units (CCUs) throughout the United Kingdom, to identify CCU medication error rate and prescription optimization, and to identify the type and impact of each intervention in the prevention of harm and improvement of patient therapy.

MATERIALS AND METHODS

A prospective observational study was undertaken in 21 UK CCUs from November 5 to 18, 2012. A data collection web portal was designed where the specialist critical care pharmacist reported all interventions at their site. Each intervention was classified as medication error, optimization, or consult. In addition, a clinical impact scale was used to code the interventions. Interventions were scored as low impact, moderate impact, high impact, and life saving. The final coding was moderated by blinded independent multidisciplinary trialists.

RESULTS

A total of 20517 prescriptions were reviewed with 3294 interventions recorded during the weekdays. This resulted in an overall intervention rate of 16.1%: 6.8% were classified as medication errors, 8.3% optimizations, and 1.0% consults. The interventions were classified as low impact (34.0%), moderate impact (46.7%), and high impact (19.3%); and 1 case was life saving. Almost three quarters of interventions were to optimize the effectiveness of and improve safety of pharmacotherapy.

CONCLUSIONS

This observational study demonstrated that both medication error resolution and pharmacist-led optimization rates were substantial. Almost 1 in 6 prescriptions required an intervention from the clinical pharmacist. The error rate was slightly lower than an earlier UK prescribing error study (EQUIP). Two thirds of the interventions were of moderate to high impact.

Carbon kagome lattice and orbital-frustration-induced metal-insulator transition for optoelectronics

A three-dimensional elemental carbon kagome lattice, made of only fourfold-coordinated carbon atoms, is proposed based on first-principles calculations. Despite the existence of 60° bond angles in the triangle rings, widely perceived to be energetically unfavorable, the carbon kagome lattice is found to display exceptional stability comparable to that of C(60). The system allows us to study the effects of triangular frustration on the electronic properties of realistic solids, and it demonstrates a metal-insulator transition from that of graphene to a direct gap semiconductor in the visible blue region. By minimizing s-p orbital hybridization, which is an intrinsic property of carbon, not only the band edge states become nearly purely frustrated p states, but also the band structure is qualitatively different from any known bulk elemental semiconductors. For example, the optical properties are similar to those of direct-gap semiconductors GaN and ZnO, whereas the effective masses are comparable to or smaller than those of Si.

Influence of active recovery on professional rugby union player's ability to harness postactivation potentiation

AIM

After postactivation potentiation (PAP) has been induced, current research recommends that, on average, an 8 minute passive recovery period is applied before engaging in subsequent dynamic exercise. However, given the importance of maximizing time usage during the warm-up of elite athletes, it is likely that further exercise would be incorporated into this time frame. This study aimed to examine the effects of passive and active recovery on the ability to utilize PAP.

METHODS

In a randomised and counter balanced design, 36 professional rugby union players completed two experimental trials involving a baseline countermovement jump (CMJ), followed by a PAP stimulus (3 x 3 repetitions at 87% of 1-RM back squat) and CMJ retesting after 8 minutes of passive or active recovery. The active recovery involved subjects performing ballistic bench throws (1 x 3 repetitions at 30% 1-RM bench press) 4 minutes after the lower body PAP stimulus. Data presented as mean±SD.

RESULTS

Baseline peak power output (PPO) was not different between conditions (P=0.61). CMJ PPO increased from baseline under both conditions, however the delta (mean±SD; passive +161±127 vs. active +116±44 W; P=0.03) and % change (passive 3.3±2.8 vs. active 2.3±0.9 %; P=0.03) in PPO was greater after the passive recovery, when compared to the active recovery.

CONCLUSION

In conclusion, the passive and active recovery periods both led to increases in lower-body PPO, nevertheless, the passive recovery elicited the greatest performance changes. However, the active recovery is a more practical option for athletes, as it maximizes time usage during warm-up.

Limits on passivating defects in semiconductors: the case of Si edge dislocations

By minimizing the free energy while constraining dopant density, we derive a universal curve that relates the formation energy (E(form)) of doping and the efficiency of defect passivation in terms of segregation of dopants at defect sites. The universal curve takes the simple form of a Fermi-Dirac distribution. Our imposed constraint defines a chemical potential that assumes the role of "Fermi energy," which sets the thermodynamic limit on the E(form) required to overcome the effect of entropy such that dopant segregation at defects in semiconductors can occur. Using Si edge dislocation as an example, we show by first-principles calculations how to map the experimentally measurable passivation efficiency to our calculated E(form) by using the universal curve for typical n- and p-type substitutional dopants. We show that n-type dopants are ineffective. Among p-type dopants, B can satisfy the thermodynamic limit while improving electronic properties.

Zero-failure option. One Tennessee hospital system benefits from creating a fully replicated set of data archives. Interview by Mark Hagland

The five-hospital Saint Thomas Health Services, anchored by Middle Tennessee Medical Center in Murfreesboro, Tenn., several years ago became one of the very first multi-hospital systems in the U.S. to create a fully replicated set of data archives, rather than simply a mirrored configuration, to support the continuity of its PACS and other capabilities. That organization's leaders have derived great benefit from their innovation.

A study of naturally occurring cases of ovine foot abscess in New Zealand

A study was made of various aspects of 53 naturally occurring cases of foot abscess in sheep in New Zealand. Radiographic techniques were used to follow the progress of the lesion and from this it was concluded that foot abscess could be defined as an infection of the distal interphalangeal joint. The term foot abscess was considered preferable to the term "infective bulbar necrosis". The attack rate of foot abscess was reported to be higher for rams than for ewes and the condition was less prevalent during summer. Once infection was established in the distal interphalangeal joint a relatively uniform and thus predictable series of events took place that inevitably resulted in some permanent damage and deformity to the digit. If rupture of the axial collateral ligaments occurred, the joint became unstable and the degree of permanent deformity was greater. Treatment with antibiotics did not appear to markedly affect the progress of the lesion or the outcome, once infection had become established in the joint. Although the prognosis for complete recovery was poor, in most cases the foot healed sufficiently after a period of about two months to allow the animal to walk normally.

Hole-mediated hydrogen spillover mechanism in metal-organic frameworks

Hydrogen spillover on carbon-based systems has been proposed as a viable alternative for room-temperature storage. Given the strength of the C-H bonds, however, it is unclear if spillover indeed takes place in such materials. We performed a first-principles study of H spillover on IRMOF-1. Spillover becomes thermodynamically stable only at high H coverage with a calculated Gibbs free energy of -14  kJ/mol at ambient condition. In general, however, spillover may not proceed due to high-energy states at lower H coverage. We propose that hole doping can substantially lower the energies as well as barriers to enable spillover at ambient conditions.