A pharmacist-physician intervention model using a computerized alert system to reduce high-risk medication use in primary care.

PURPOSE: Potentially inappropriate medications (PIMs) have been associated with a greater risk of adverse drug events and hospitalizations. To reduce PIMs use, a family health team (FHT) implemented a knowledge translation (KT) strategy that included a pharmacist-physician intervention model based on alerts from a computerized alert system (CAS). METHODS: Our pragmatic, single-site, pilot study was conducted in an FHT clinic in Quebec, Canada. We included community-dwelling older adults (≥ 65 years), with at least 1 alert for selected PIMs and a medical appointment during the study period. PIMs were selected from the Beers and STOPP criteria. The primary outcome was PIMs cessation, decreased dose, or replacement. The secondary outcome was the clinical relevance of the alerts as assessed by the pharmacists. RESULTS: During the 134 days of the study, the CAS screened 369 individuals leading to the identification of 65 (18%) patients with at least 1 new alert. For those 65 patients, the mean age was 77 years, men accounted for 29% of the group and 55% were prescribed 10 or more drugs. One or more clinically relevant alerts were generated for 27 of 65 included patients for an overall clinical relevance of the alerts of 42%. Of the 27 patients with at least 1 relevant alert, 17 (63%) had at least 1 medication change as suggested by the pharmacist. CONCLUSION: An interdisciplinary pharmacist-physician intervention model, based on alerts generated by a CAS, reduced the use of PIMs in community-dwelling older adults followed by an FHT.

Correlation effects in molecular conductors.

The source-sink potential (SSP) model introduced previously [F. Goyer, M. Ernzerhof, and M. Zhuang, J. Chem. Phys. 126, 144104 (2007)] enables one to eliminate the semi-infinite contacts in molecular electronic devices (MEDs) in favor of complex potentials. SSP has originally been derived for independent electrons and extended to interacting two-electron systems subsequently [A. Goker, F. Goyer, and M. Ernzerhof, J. Chem. Phys. 129, 194901 (2008)]. Here we generalize SSP to N-electron systems and consider the impact of electron correlation on the transmission probability. In our correlated method for molecular conductors, the molecular part of the Hückel Hamiltonian of the original SSP is replaced by the Hubbard Hamiltonian. For the contacts, however, the single-electron picture is retained and they are assumed to be spin polarized. Using our method, we study electron transmission in molecular wires, cross-conjugated chains, as well as aromatic systems. We find that, for realistic values of the electron-electron repulsion parameter, correlation effects modify the transmission probability quantitatively, the qualitative features remain. However, we find subtle new effects in correlated MEDs, such as Coulomb drag, that are absent in uncorrelated systems.

The Prescription of Drug Ontology 2.0 (PDRO): More Than the Sum of Its Parts.

While drugs and related products have profoundly changed the lives of people around the world, ongoing challenges remain, including inappropriate use of a drug product. Inappropriate uses can be explained in part by ambiguous or incomplete information, for example, missing reasons for treatments, ambiguous information on how to take a medication, or lack of information on medication-related events outside the health care system. In order to fully assess the situation, data from multiple systems (electronic medical records, pharmacy and radiology information systems, laboratory management systems, etc.) from multiple organizations (outpatient clinics, hospitals, long-term care facilities, laboratories, pharmacies, registries, governments) on a large geographical scale is needed. Formal knowledge models like ontologies can help address such an information integration challenge. Existing approaches like the Observational Medical Outcomes Partnership are discussed and contrasted with the use of ontologies and systems using them for data integration. The PRescription Drug Ontology 2.0 (PDRO 2.0) is then presented and entities that are paramount in addressing this problematic are described. Finally, the benefits of using PDRO are discussed through a series of exemplar situation.

High-dose vitamin-C induced prolonged factitious hyperglycemia in a peritoneal dialysis patient: a case report.

BACKGROUND: High-dose vitamin C is increasingly used for sepsis and more recently for coronavirus disease 2019 (COVID-19) infections. Proponents argue that the low cost and near perfect safety profile of vitamin C support its early adoption. Yet, adverse events might be underreported and underappreciated. CASE PRESENTATION: We report a 73-year-old non-diabetic white man with end-stage renal disease on peritoneal dialysis admitted to the intensive care unit with septic shock that was suspected to be due to peritonitis. The patient was enrolled in LOVIT (Lessening Organ Dysfunction with VITamin C; ClinicalTrials.gov identifier: NCT03680274), a randomized placebo-controlled trial of high-dose intravenous vitamin C. He developed factitious hyperglycemia, as measured with a point-of-care glucometer, that persisted for 6 days after discontinuation of the study drug, confirmed to be vitamin C after unblinding. He also had short-lived iatrogenic coma because of hypoglycemia secondary to insulin administration. These events triggered a protocol amendment. CONCLUSIONS: Although factitious hyperglycemia has been reported before using certain glucometers in patients treated with high-dose vitamin C, the persistence of this phenomenon for 6 days after the discontinuation of the therapy is a distinguishing feature. This case highlights the importance of monitoring glucose with a core laboratory assay for up to a week in specific populations, such as patients on peritoneal dialysis.

Bond dissociation and correlation effects in molecular electronic devices.

We present a simple model for a fundamental process in molecular electronics: The change in conductance upon bond breaking. In our model, a diatomic molecule is attached to spin-polarized contacts. Employing a Hubbard Hamiltonian, electron interaction is explicitly considered in the molecule and neglected in the contacts, enabling us to study the impact of electron interaction on the molecular conductance. In the limit where the electron repulsion is strong compared to the binding energy (as is the case upon dissociation), electron transmission is strongly suppressed compared to the noninteracting case. On the other hand, the spin-polarized contacts introduce a coupling between the molecular singlet and triplet states, as a consequence of which the energy gap between the lowest resonances is reduced.

Conjugated Molecules Described by a One-Dimensional Dirac Equation.

Starting from the Hückel Hamiltonian of conjugated hydrocarbon chains (ethylene, allyl radical, butadiene, pentadienyl radical, hexatriene, etc.), we perform a simple unitary transformation and obtain a Dirac matrix Hamiltonian. Thus already small molecules are described exactly in terms of a discrete Dirac equation, the continuum limit of which yields a one-dimensional Dirac Hamiltonian. Augmenting this Hamiltonian with specially adapted boundary conditions, we find that all the orbitals of the unsaturated hydrocarbon chains are reproduced by the continuous Dirac equation. However, only orbital energies close to the highest occupied molecular orbital/lowest unoccupied molecular orbital energy are accurately predicted by the Dirac equation. Since it is known that a continuous Dirac equation describes the electronic structure of graphene around the Fermi energy, our findings answer the question to what extent this peculiar electronic structure is already developed in small molecules containing a delocalized π-electron system. We illustrate how the electronic structure of small polyenes carries over to a certain class of rectangular graphene sheets and eventually to graphene itself. Thus the peculiar electronic structure of graphene extends to a large degree to the smallest unsaturated molecule (ethylene).

Source and sink potentials for the description of open systems with a stationary current passing through.

The authors present a model Hamiltonian for the description of open systems that exchange probability current density with their surroundings. The complex potentials appearing in this Hamiltonian act as source and sink, respectively, of probability current density. The primary applications of the theory of source and sink potentials are molecular electronic devices (MEDs), in the description of which the semi-infinite contacts are replaced by complex potentials. This is done in a rigorous manner, i.e., the exact wave function is recovered in the interior of the MED. To illustrate the approach, certain prototypical molecular conductors are considered in the Huckel approximation. The authors show that, for the examples considered, there exist almost isolated molecular states in the continuum of contact states that manifest themselves as Fano resonances in the transmission probability. The findings are confirmed by density functional theory calculations that also yield the predicted molecular states that are nearly decoupled from the contacts.

Electron Transmission through Aromatic Molecules.

A prominent feature of aromatic compounds is the ring current that can be observed indirectly in nuclear magnetic resonance experiments. This current is generated by an external magnetic field. In molecular electronics, molecules serve as conductors, and they are connected to metallic contacts that act as electron sources and electron sinks. We show that ring currents can also be found in molecular electronic devices containing cyclic π-electron systems. The circular currents are related to interference phenomena that can render the molecule impenetrable to electrons. While only small currents pass through the molecule, large internal circular currents are stimulated. We conjecture that the internal currents should result in experimentally observable magnetic moments.