Evaluating a Pharmacist-Initiated Care Bundle for Patients with Chronic Obstructive Pulmonary Disease.

Background: Chronic obstructive pulmonary disease (COPD) is a cause of significant morbidity and mortality, and management of patients with this complex disease remains a challenge. Pharmacists work within an interdisciplinary health care team to coordinate services and ensure that standards of care are met. A pharmacist-initiated care bundle provided in the outpatient setting has shown promising results in improving COPD management. Objective: To evaluate, in the acute care setting, the effectiveness of a pharmacist-initiated COPD care bundle in improving compliance with health care measures known to improve outcomes in patients with COPD. Methods: This retrospective chart review included patients with acute exacerbation of COPD admitted from May 14, 2019, to February 29, 2020. Completion rates for the 6 individual components of the COPD care bundle were compared between patients who did and did not receive the pharmacist-initiated intervention. A subgroup of 22 patients received the following additional interventions: documentation of the modified Medical Research Council score, assessment of COPD medications, and vaccination review and administration. Results: A total of 106 patients were included in the analysis, 53 patients in each of the control and intervention groups. The pharmacist-initiated intervention increased completion rates for the overall COPD care bundle from 2% to 17% (p = 0.003), for provision of the COPD flare-up action plan from 4% to 79% (p < 0.001), and for provision of smoking cessation education from 0% to 36% (p = 0.04); however, there was no significant difference in assessment by a respiratory therapist. For the subgroup that received additional interventions, vaccination reviews were conducted for 21 (96%) of the 22 patients, which led to 9 (41%) receiving a guideline-recommended vaccine. Conclusions: Pharmacist involvement in initiation of the care bundle significantly increased completion rates for the activities included in the care bundle.

Contexte: La maladie pulmonaire obstructive chronique (MPOC) est une cause d'une morbidité et d'une mortalité importantes, et la prise en charge des patients atteints de cette maladie complexe demeure un défi. Les pharmaciens travaillent au sein d'une équipe interdisciplinaire de soins de santé pour coordonner les services et s'assurer du respect des normes de soins. Un ensemble de soins initié par le pharmacien en milieu ambulatoire a donné des résultats prometteurs dans l'amélioration de la prise en charge de la MPOC. Objectif: Évaluer, dans le cadre des soins aigus, l'efficacité d'un ensemble de soins pour la MPOC initié par un pharmacien pour améliorer le respect des mesures de soins de santé connues pour améliorer les résultats chez les patients atteints de MPOC. Méthodes: Cet examen rétrospectif des dossiers comprenait des patients présentant une exacerbation aiguë de la MPOC admis du 14 mai 2019 au 29 février 2020. Les taux de réussite pour les 6 composantes individuelles de l'ensemble de soins pour la MPOC ont été comparés entre les patients ayant reçu et ceux n'ayant pas reçu l'intervention initiée par le pharmacien. Un sous-groupe de 22 patients a reçu des interventions supplémentaires : documentation du score modifié du Medical Research Council (mMRC), évaluation des médicaments pour la MPOC, et examen et administration de la vaccination. Résultats: Au total, 106 patients ont été inclus dans l'analyse : 53 patients dans le groupe de contrôle et 53 dans le groupe d'intervention. L'intervention initiée par le pharmacien a augmenté les taux d'adhésion à l'ensemble de soins pour la MPOC de 2 % à 17 % (p = 0,003), de 4 % à 79 % (p < 0,001) pour l'offre du plan d'action en cas de poussée de MPOC et de 0 % à 36 % (p = 0,04) pour l'éducation au sevrage tabagique; cependant, l'évaluation par un inhalothérapeute n'a permis de déceler aucune différence significative. Dans le sous-groupe ayant reçu des interventions supplémentaires, des examens de vaccination ont été menés chez 21 (96 %) des 22 patients; 9 patients (41 %) ont ainsi reçu un vaccin recommandé par les lignes directrices. Conclusions: La participation du pharmacien à l'initiation de l'ensemble de soins a augmenté de manière significative les taux de réussite des activités incluses dans l'ensemble de soins.

Familial partial lipodystrophy presenting as metabolic syndrome.

We report the first described case of a heterozygous p.R545H (c.1634 G > A) missense mutation in the LMNA gene with clinical features compatible with Dunnigan-type 2 familial partial lipodystrophy (FPLD2). The case presented as metabolic syndrome to a specialist clinical service and highlights the overlap between FPLD2 and the metabolic syndrome. The associations with type 2 diabetes mellitus, fatty liver disease, polycystic ovarian syndrome, and hypertriglyceridemia are highlighted. The importance of evaluating patients for these associated conditions is discussed, and the potential mechanisms of disease are briefly outlined. The mutation has been previously reported in a heart failure database without a clinical description. The links between heart failure and the clinical condition are briefly considered.

The ultrastructure of the cardiac ganglion of the desert scorpion, Paruroctonus mesaensis (Scorpionida: Vaejovidae).

Light and electron microscopy of the pacemaker ganglion of the scorpion heart indicate that it is about 15 mm long and 50 µm in diameter and extends along the dorsal midline of the heart. The largest cell bodies (30-45 µm in diameter) occur in clusters along the length of the ganglion. The ganglion appears to be innervated with fibers from the subesophageal and first three abdominal ganglia. The cardiac ganglion is surrounded by a neurilemma and a membranous sheath. The latter is apparently derived from connective tissue cells seen outside the ganglion. Nerve fibers other than those in the neuropil areas are usually surrounded by membrane and cytoplasm of glial cells. Often there are several layers of glial membrane, forming a loose myelin. The cardiac nerves to the heart muscle are also surrounded by a neurilemma, and the axons are surrounded by glia. The motor nerves contain lucent vesicles 60-100 nm and opaque granules 120-180 nm in diameter. In the cardiac ganglion, some nerve cell bodies have complex invaginations of glial processes forming a peripheral trophospongium. In the neuropil areas, nerve cell processes are often in close apposition. The septilaminar configuration typical of gap junctions is common, with gap distances of 1-4 nm. In tissues stained with lanthanum phosphate during fixation, we found gaps with unstained connections (1-2 nm diameter) between nerve-nerve and glial-nerve cell processes. Annular or double-membrane vesicles in various stages of formation were also seen in some nerve fibers in ganglia stained with lanthanum phosphate. Nerve endings with electron-lucent vesicles 40-60 nm in diameter are abundant in the cardiac ganglion, suggesting that these contain the excitatory transmitter of intrinsic neurons of the ganglion. Less abundant are fibers with membrane-limited opaque granules, circular or oblong in shape and as much as 330 nm in their longest dimension. Also seen were some nerve endings with both vesicles and granules.