Professional-development and continuing-education programs for pharmacists in large hospitals

Pharmacy directors at large hospitals nationwide were surveyed to determine the status of professional-development and continuing-education programs for staff pharmacists at their institutions. An 18-item questionnaire was developed and mailed in July 1987 to pharmacy directors of 445 large (bed capacity of greater than or equal to 450) hospitals. The questionnaire was designed to elicit information about who holds responsibility for the professional-development programs, the programs' frequency and format, how attendance is documented, and the types of individuals who present the programs. A total of 327 (73.5%) of the questionnaires were returned, with 256 (78.3%) of the respondents indicating that their department had some form of developmental-training program. Only 45 (17.6%) of these respondents indicated that their department employed an individual whose job title was specific for education or training functions. Hour-long lectures and videotaped programs were the most popular formats; programs were most frequently presented by pharmaceutical sales representatives or clinical or staff pharmacists. Of 251 respondents, only 90 (35.8%) indicated that an educational needs assessment of pharmacists had been conducted in the 18 months before the survey. Of 252 respondents, 138 (54.8%) indicated that their departments had no annual budget for these programs. Although program attendance was documented by 248 (97.3%) of the 256 departments, 111 (43.3%) did not require any type of certification for some programs. Evaluations were required by only 127 (49.6%) of the 256 pharmacy departments offering these programs. Inhouse programs offer opportunities for professional development, but resource allocation, program organization, and incentives for participation such as standards of performance could be improved in many of the programs explored by this survey.

Antenatally diagnosed subdural haemorrhage in congenital factor X deficiency

The presence of a subdural haemorrhage was observed in a fetus during antenatal ultrasound examination. The infant was found to be a homozygote for factor X deficiency. Prompt recognition permitted replacement treatment from an early stage. Inherited coagulation disorders should be suspected when intracranial haemorrhage is detected antenatally.

The valence of dreams reported by type A-B college students

The valences of the dreams reported by Type A (n = 39) and Type B (n = 42) undergraduates were examined. Consistent with the view that in part the manifest content of the dream may reflect attempts to manage stress, the Type A students were significantly more likely than the Type B students, to report disturbing dreams.

Hypovitaminosis A in feedlot cattle

Hypovitaminosis A was diagnosed in a group of feedlot cattle that had been fed a diet low in carotene for 18 months. The primary signs of disease in the cattle were poor weight gain, ataxia, convulsions, night blindness, and total blindness. Serum vitamin A concentrations were used to confirm the diagnosis. The cattle were treated orally and intramuscularly with vitamin A, and the less severely affected herd members recovered rapidly.

Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index

A retrospective review of 676 tibial-fibular fractures and 985 femoral fractures treated over a 71-month period yielded associated major vascular trauma in 12 (1.7%) tibial-fibular fractures and in five (0.5%) femoral fractures. Vascular trauma combined with orthopedic trauma was also identified in four other cases--two disruptions of the pubic symphysis and two dislocations of the knee without fracture. Nine (43%) of the 21 involved limbs were eventually amputated. Limb survival was not related to the temporal relationship of vessel repair to skeletal stabilization; the presence or absence of shock on admission; the presence of associated but repaired venous injury; or the presence of unrelated injuries. Limb survival was related to the interval from injury to arrival in the operating room; the level of arterial injury; and the quantitative degree of muscle, bone, and skin injury. By combining these variables a limb salvage index was established that identified lower extremities likely to require amputation after combined orthopedic and vascular trauma (sensitivity 78%, specificity 100%). Use of this predictive salvage index may prevent the trauma surgeon from attempting to salvage a doomed or useless lower extremity and may thus permit early prosthetic rehabilitation to follow definitive primary amputation.

Episodic abnormalities in transcutaneous oxygen (TcPO2) recorded during neonatal intensive care

An automated TcPO2 data system was tested and used to: 1) quantitate the frequency and duration of hypoxemic and hyperoxemic events experienced during the first three days after birth by 25 very low birth weight infants, and 2) determine whether hypoxemic events were associated with the occurrence of periventricular-intraventricular hemorrhage. During the first three days after birth, infants experienced a median of 41 episodes with a TcPO2 less than 40 torr having a cumulative duration of 37 minutes, and a median of 28 episodes with a TcPO2 greater than 100 torr having a cumulative duration of 14 minutes. Most episodes were less than 30 seconds in duration, but in some infants the duration was longer. There was no association between the occurrence of periventricular-intraventricular hemorrhage and either the frequency or cumulative duration of episodes with a TcPO2 less than 40 torr. A major problem with automated TcPO2 data systems is the inability of currently available systems to recognize inaccurate TcPO2 data. Twenty-four per cent of the summary TcPO2 monitoring data collected in this study was contaminated with unreliable TcPO2 values. Before automated TcPO2 data systems can be recommended for widespread research use or for medicolegal documentation, the problem of data contamination must be resolved.

Antibody to mouse alpha/beta interferon abrogates Pichinde virus-induced liver lesions in suckling mice

Infection of newborn C3HeB/FeJ mice with the arenavirus Pichinde resulted in stunted growth, severe liver cell degeneration, and death. Administration of sheep anti-mouse alpha/beta interferon globulin completely abrogated liver lesions in virus-infected mice, although it did not decrease the incidence of mortality. These results indicate that endogenous interferon may be responsible for some manifestations of viral disease.

Vascular smooth muscle caldesmon

Caldesmon, a major actin- and calmodulin-binding protein, has been identified in diverse bovine tissues, including smooth and striated muscles and various nonmuscle tissues, by denaturing polyacrylamide gel electrophoresis of tissue homogenates and immunoblotting using rabbit anti-chicken gizzard caldesmon. Caldesmon was purified from vascular smooth muscle (bovine aorta) by heat treatment of a tissue homogenate, ion-exchange chromatography, and affinity chromatography on a column of immobilized calmodulin. The isolated protein shared many properties in common with chicken gizzard caldesmon: immunological cross-reactivity, Ca2+-dependent interaction with calmodulin, Ca2+-independent interaction with F-actin, competition between actin and calmodulin for caldesmon binding only in the presence of Ca2+, and inhibition of the actin-activated Mg2+-ATPase activity of smooth muscle myosin without affecting the phosphorylation state of myosin. Maximal binding of aorta caldesmon to actin occurred at 1 mol of caldesmon: 9-10 mol of actin, and binding was unaffected by tropomyosin. Half-maximal inhibition of the actin-activated myosin Mg2+-ATPase occurred at approximately 1 mol of caldesmon: 12 mol of actin. This inhibition was also unaffected by tropomyosin. Caldesmon had no effect on the Mg2+-ATPase activity of smooth muscle myosin in the absence of actin. Bovine aorta and chicken gizzard caldesmons differed in several respects: Mr (149,000 for bovine aorta caldesmon and 141,000 for chicken gizzard caldesmon), extinction coefficient (E1%280nm = 19.5 and 5.0 for bovine aorta and chicken gizzard caldesmon, respectively), amino acid composition, and one-dimensional peptide maps obtained by limited chymotryptic and Staphylococcus aureus V8 protease digestion. In a competitive enzyme-linked immunosorbent assay, using anti-chicken gizzard caldesmon, a 174-fold molar excess of bovine aorta caldesmon relative to chicken gizzard caldesmon was required for half-maximal inhibition. These studies establish the widespread tissue and species distribution of caldesmon and indicate that vascular smooth muscle caldesmon exhibits physicochemical differences yet structural and functional similarities to caldesmon isolated from chicken gizzard.

Identification of bovine brain Ca2+-binding proteins

In a previous communication (Waisman, D.M., Smallwood, J.I., Lafreniere, D. and Rasmussen, H. (1983) Biochem, Biophys. Res. Commun. 116, 435-441) we reported that chromatography of bovine brain 100,000 X g supernatant on diethylaminoethyl (DEAE) cellulose and analysis of resultant fractions by chelex competitive calcium binding assay, resolved three peaks of calcium binding activity. Gel permeation chromatographic analysis of each peak resolved apparent Mr 40,000 (Peak I), Mr 75,000, Mr 230,000 and Mr 420,000 (Peak II), and Mr 38,000 (Peak III). In the present communication the calcium binding proteins responsible for the calcium binding activity peaks resolved by gel permeation chromatography, have been purified and identified as caligulin, (Mr 40,000), calcineurin, (Mr 230,000) and calmodulin, (Mr 38,000). In addition, a novel calcium binding protein (Mr 48,000 by SDS PAGE) has been identified from the Mr 75,000 calcium binding activity peak.

On the early recognition of neuroleptic malignant syndrome

Neuroleptic Malignant Syndrome, a serious and sometimes fatal complication, has been reported to occur in some patients with the administration of neuroleptic medications. Clinically it is manifested by four groups of symptoms which include muscular hypertonicity, autonomic instability, altered consciousness, and hyperthermia. Laboratory findings such as elevated creatinine phosphokinase and leukocytosis are also seen. While it is true that the incidence of the full blown clinical picture of this syndrome is rare, the authors report that only muscular hypertonicity and autonomic instability have occurred frequently in their setting leading to discontinuation of neuroleptics. Such abortive cases may go undetected. If properly diagnosed, the occurrence of this syndrome is not as rare as the published reports indicate. Second, it is reported that rechallenge with neuroleptics may not induce Neuroleptic Malignant Syndrome again. The authors noted recurrence of fever after rechallenge with a different neuroleptic drug. This article describes the method of early recognition and prevention of morbidity as well as mortality.

Clinical experience with a new combination formulation of triamterene and hydrochlorothiazide (Maxzide) in patients with mild to moderate hypertension

The results of an investigation to assess the clinical responses of patients with mild to moderate hypertension to a new combination formulation containing 75 mg triamterene and 50 mg hydrochlorothiazide are reported. One hundred fifty-six subjects entered the investigation. Subjects were divided into three groups, depending on whether they took two (group 1) or four capsules per day of a currently available formulation of triamterene and hydrochlorothiazide (Dyazide), or no antihypertensive medication prior to the start of the study. These medications were continued for an additional two weeks to generate baseline data. Thereafter, subjects received one tablet of the new combination formulation for four weeks. Seventy of the 156 participants received the new formulation for an additional period of at least 20 weeks. Observations during the study included sitting and standing pulse and blood pressure, weight, and serum electrolytes, uric acid, creatinine, and blood urea nitrogen levels. The results of the investigation indicated that subjects transferred to the new combination drug maintained normal serum electrolyte values, including potassium, with no or minor changes in the levels of uric acid, creatinine, and blood urea nitrogen. Reductions in systolic and diastolic blood pressure were observed in all three study groups, including subjects receiving two or four capsules of Dyazide per day in the two-week baseline period. We conclude that mild to moderately hypertensive subjects taking no medication or either two or four capsules of Dyazide per day may be transferred safely to the new combination product of triamterene and hydrochlothiazide.

Clinical evaluation of the Abbott TDx fluorescence polarization immunoassay analyzer

The Abbott TDx fluorescence polarization immunoassay (FPIA) system was evaluated and compared with well-established enzyme multiplied immunoassay technique (EMIT) and radioimmunoassay (RIA) methods utilizing five high-volume drug assays including theophylline, gentamicin, phenytoin, phenobarbital, and digoxin. These drug assays were evaluated for precision, calibration stability, specificity, and accuracy. Within-run precision studies utilizing control samples (n = 20) in the subtherapeutic, therapeutic, and toxic ranges resulted in coefficients of variation (CV) of less than 4.0% for the theophylline, gentamicin, phenytoin, and phenobarbital assays and of less than 9.5% for the digoxin assay. Between-run precision studies based on an initial TDx calibration curve over a 2-3 week period yielded CVs of less than 8% for all five drug assays. Cross-reactivity of the FPIA gentamicin assay with concurrently used aminoglycosides such as tobramycin and amikacin was less than 0.1%, and interference due to hemolysis and lipemia was negligible. Highly icteric specimens resulted in clinically significant decreases in theophylline and phenytoin concentrations, but this problem can be corrected by subtraction of blank intensity values. Comparison of the FPIA method with the EMIT and RIA methods indicated an extremely good analytical correlation (r greater than 0.97) for all five comparisons. The Abbott TDx FPIA system offers significant advantages in calibration and reagent stability, and greater sensitivity in the low drug concentration ranges while maintaining accuracy and precision comparable with those of established EMIT and RIA procedures.