Understanding the information-seeking behavior of pharmacy college faculty, staff, and students: implications for improving embedded librarian services.

OBJECTIVE: Research was conducted on the embedded librarian program at The University of Arizona College of Pharmacy and the Health Sciences Library to understand how this service is relevant to users and identify the potential for further improvement. This study examined users' information-seeking behaviors and considered the implications for the effectiveness of the embedded librarian service. METHODS: The authors conducted 18 semi-structured interviews of faculty, researchers, and students at the College of Pharmacy to obtain descriptive accounts of how they seek information, manage information, and use the library and library services. The authors examined the interview transcripts through qualitative descriptive analysis. RESULTS: The interview responses confirm that users seek information outside of the physical library and tend to ask their peers for information or assistance in obtaining information. They mostly feel comfortable in searching, but some of them may lack sufficient search skills and tend to use a few known databases. While those who are familiar with the librarian seek the librarian's assistance more often, others tend not to seek the librarian's assistance. The ways they manage information vary, which requires customized assistance. CONCLUSIONS: The close proximity of a physically embedded librarian is beneficial to users and positions the librarian to provide proactive assistance in the existing user information-seeking behavior environment. While some users do not seek assistance, the embedded librarian can provide proactive assistance in such areas as making users aware of other database options and helping them choose relevant databases and effectively manage information.

Sodium Thiosulfate Improves Intestinal and Hepatic Microcirculation Without Affecting Mitochondrial Function in Experimental Sepsis.

Introduction: In the immunology of sepsis microcirculatory and mitochondrial dysfunction in the gastrointestinal system are important contributors to mortality. Hydrogen sulfide (H2S) optimizes gastrointestinal oxygen supply and mitochondrial respiration predominantly via K(ATP)-channels. Therefore, we tested the hypothesis that sodium thiosulfate (STS), an inducer of endogenous H2S, improves intestinal and hepatic microcirculation and mitochondrial function via K(ATP)-channels in sepsis. Methods: In 40 male Wistar rats colon ascendens stent peritonitis (CASP) surgery was performed to establish sepsis. Animals were randomized into 4 groups (1: STS 1 g â€¢ kg-1 i.p., 2: glibenclamide (GL) 5 mg • kg-1 i.p., 3: STS + GL, 4: vehicle (VE) i.p.). Treatment was given directly after CASP-surgery and 24 hours later. Microcirculatory oxygenation (µHBO2) and flow (µflow) of the colon and the liver were continuously recorded over 90 min using tissue reflectance spectrophotometry. Mitochondrial oxygen consumption in tissue homogenates was determined with respirometry. Statistic: two-way ANOVA + Dunnett´s and Tukey post - hoc test (microcirculation) and Kruskal-Wallis test + Dunn's multiple comparison test (mitochondria). p < 0.05 was considered significant. Results: STS increased µHbO2 (colon: 90 min: + 10.4 ± 18.3%; liver: 90 min: + 5.8 ± 9.1%; p < 0.05 vs. baseline). Furthermore, STS ameliorated µflow (colon: 60 min: + 51.9 ± 71.1 aU; liver: 90 min: + 22.5 ± 20.0 aU; p < 0.05 vs. baseline). In both organs, µHbO2 and µflow were significantly higher after STS compared to VE. The combination of STS and GL increased colonic µHbO2 and µflow (µHbO2 90 min: + 8.7 ± 11.5%; µflow: 90 min: + 41.8 ± 63.3 aU; p < 0.05 vs. baseline), with significantly higher values compared to VE. Liver µHbO2 and µflow did not change after STS and GL. GL alone did not change colonic or hepatic µHbO2 or µflow. Mitochondrial oxygen consumption and macrohemodynamic remained unaltered. Conclusion: The beneficial effect of STS on intestinal and hepatic microcirculatory oxygenation in sepsis seems to be mediated by an increased microcirculatory perfusion and not by mitochondrial respiratory or macrohemodynamic changes. Furthermore, the effect of STS on hepatic but not on intestinal microcirculation seems to be K(ATP)-channel-dependent.

Performance Characteristics of DOAC Dipstick in Determining Direct Oral Anticoagulants in Urine.

Testing for direct oral anticoagulants (DOACs) in patient urine may facilitate medical treatment decisions. The aim of this study was to investigate interobserver variability by 2 independent observers compared to laboratory staff in the visual interpretation of factor Xa (DXI) and thrombin inhibitors (DTI) using the DOAC Dipstick test. We also examined whether test pads reacted to other anticoagulants and abnormal urine colors. The colors of the DOAC Dipstick direct factor Xa inhibitor and thrombin inhibitor pads were interpreted with 100% accuracy (95% confidence interval 0.862 to 1.000) for urine samples from persons treated with apixaban (n = 26), rivaroxaban (n = 24), and dabigatran (n = 29) and without anticoagulant therapy (n = 29). The factor Xa and thrombin inhibitor pads did not interact with heparin, nadroparin, fondaparinux, or coumadin. One µg/mL r-Hirudin and 6 µg/mL argatroban interacted with the DTI pad; however, this is unlikely to cause clinical problems because dabigatran is unlikely to be administered together with r-Hirudin and argatroban in clinical circumstances. Abnormal urine color was reliably detected by the urine color pad, so can prevent false interpretation of the DOAC Dipstick pad colors. In conclusion, we have demonstrated that interobserver variability when interpreting the DOAC Dipstick test strip is low and that factor Xa and thrombin inhibitor pads do not react to other anticoagulants such as heparins and coumadin. R-Hirudin and argatroban can be detected by the thrombin inhibitor pad and abnormal urine colors can be detected by the urine color pad to prevent false interpretation of the results in patient urine samples.

A Systematic Review of Interventions to Enhance Healthy Lifestyle Behaviors in Adolescents Delivered via Mobile Phone Text Messaging.

OBJECTIVE: To systematically review healthy lifestyle interventions targeted to adolescents and delivered using text messaging (TM). DATA SOURCE: PubMed, Embase, CINAHL, PsycINFO, and Web of Science databases. Study Inclusion Criteria: Research articles published during 2011 to 2014; analyses focused on intervention targeting adolescents (10-19 years), with healthy lifestyle behaviors as main variables, delivered via mobile phone-based TM. DATA EXTRACTION: The authors extracted data from 27 of 281 articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. DATA SYNTHESIS: Adolescent and setting characteristics, study design and rigor, intervention effectiveness, challenges, and risk of bias. RESULTS: Across studies, 16 (59.3%) of 27 included non-Caucasians. The gender was split for 22 (81.5%) of 27 studies. Thirteen studies were randomized controlled trials. There was heterogeneity among targeted conditions, rigor of methods, and intervention effects. Interventions for monitoring/adherence (n = 8) reported more positive results than those for health behavior change (n = 19). Studies that only included message delivered via TM (n = 14) reported more positive effects than studies integrating multiple intervention components. Interventions delivered using TM presented minimal challenges, but selection and performance bias were observed across studies. CONCLUSION: Interventions delivered using TM have the potential, under certain conditions, to improve healthy lifestyle behaviors in adolescents. However, the rigor of studies varies, and established theory and validated measures have been inconsistently incorporated.

Patients' serum and urine as easily accessible samples for the measurement of non-vitamin K antagonist oral anticoagulants.

Measurement of the anticoagulant effect of non-vitamin K antagonist oral anticoagulants (NOAC) may be desirable, in particular in patients with acute medical conditions. Useful methods should give results rapidly within minutes, should be easy to perform, specific, and sensitive. Using plasma samples, chromogenic assays can be made to be specific for the two types of NOAC (factor Xa and thrombin inhibitors), and also hemoclot and ecarin clotting time specific for dabigatran. If plasma samples anticoagulated with sodium citrate are not available, blood samples anticoagulated with ethylene diamine tetraacetic acid or serum samples may be regarded as alternatives for the determination of NOAC. At present, dabigatran cannot be determined from serum samples because it may be consumed during the clotting process to obtain serum. NOAC can be determined in urine samples due to their renal elimination. Quantitative methods are preferable to qualitative methods, although the latter may be advantageous in some situations, being developed as point-of-care tests for oral factor Xa and thrombin inhibitors. In these tests, the presence and absence of NOAC in urine can be identified with the naked eye after a few minutes and these tests are highly specific and sensitive. New assays such as a semiquantitative determination in urine samples and measurement using other sample matrices are currently under development.

Determination of dabigatran in plasma, serum, and urine samples: comparison of six methods.

BACKGROUND: Assessing the anticoagulant effect of dabigatran may be useful in certain clinical settings. When plasma sampling is not available, serum or urine samples may provide another option for dabigatran determinations. METHODS: Dabigatran was assessed in patients on treatment under real-life conditions in plasma samples by four clotting time-based assays and in plasma, serum, and urine samples by two chromogenic substrate methods. RESULTS: The concentrations of dabigatran in patients' plasma samples were not different for the Hemoclot test (106.8±89.4 ng/mL) and the ecarin clotting time (ECT, 109.5±74.5 ng/mL, p=0.58). Activated partial thromboplastin time and prothrombinase-induced clotting time showed low correlations with the other assays. Chromogenic assays measured similar concentrations as Hemoclot and ECT. For both chromogenic assays, the concentrations of dabigatran were about 70% lower in serum than in plasma samples (p<0.0001). The intra-class coefficient (ICC, Bland-Altman analysis) was strong comparing ECT, Hemoclot thrombin inhibitor (HTI) assay, and the two chromogenic assays (r=0.889-0.737). The ICC was low for comparisons of the chromogenic assays of serum vs. plasma values (ICC, 0.15 and 0.66). The ICC for the determination of dabigatran in urine samples by the two chromogenic assays (5641.6±4319.7 and 4730.0±3770.2 ng/mL) was 0.737. CONCLUSIONS: ECT, HTI, and chromogenic assays can be used to determine dabigatran in plasma samples from patients under real-life conditions. Chromogenic assays require further improvement to reliably measure dabigatran in serum samples. Dabigatran concentrations in urine samples can also be determined quantitatively.

Measurement of Non-Vitamin K Antagonist Oral Anticoagulants in Patient Plasma Using Heptest-STAT Coagulation Method.

BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) are approved for several indications for prophylaxis of thromboembolism at fixed oral doses. The analysis of NOAC activity/concentration may be required in special patient populations. Heptest coagulation assay determines both factor Xa and thrombin inhibitors. The objective of investigations is to analyze the effects of both groups of NOACs on this assay. METHODS: The performance of a modified Heptest-STAT clotting assay was compared with specific chromogenic substrate assays for factor Xa (Coamatic, HemosIL) and thrombin (direct thrombin inhibitor assay and S2238 chromogenic assays) for the determination of rivaroxaban, apixaban, and dabigatran in plasma from patients on treatment. RESULTS: For rivaroxaban (n = 74), the concentrations (mean and SD) of Heptest-STAT versus Coamatic and HemosIL assays were 179.3 ± 85.8 ng/mL versus 199.3 ± 105.7 ng/mL and 212.4 ± 115.9 ng/mL (P < 0.0001), and for apixaban (n = 26) 232.8 ± 10.0 ng/mL versus 178.4 ± 64.4 ng/mL (P < 0.0001) and 182.1 ± 73.1 ng/mL (P = 0.0002). For dabigatran (n = 74), the values of Heptest-STAT were 92.3 ± 65.0 ng/mL versus 124.3 ± 85.6 ng/mL (direct thrombin inhibitor assay, P < 0.0001) and 107.5 ± 59.7 ng/mL (S2238 assay, P = 0.0015), respectively. The values of the intraclass coefficient of correlation ranged from 0.64 to 0.91 (Bland-Altman analysis). CONCLUSIONS: The objective of the study was achieved by demonstrating a high correlation of the Heptest-STAT coagulation assay with chromogenic assays for factor Xa inhibiting NOACs and acceptably good correlation with thrombin inhibiting NOACs in plasma samples of patients on treatment.

Glycosaminoglycans: anticoagulant and nonanticoagulant actions: a short history of symposia held at villa vigoni.

Heparin, a sulfated polysaccharide belonging to the family of glycosaminoglycans, was discovered in the beginning of the 20th century and was initially identified as a procoagulant isolated from liver tissue. After the first application in patients approximately 30 years later, further purification identified the major as well as minor, but important, component units of the complex chain mixtures constituting heparin and the multiplex actions became a scientific challenge recently. A series of "Glycosaminoglycan symposium-anticoagulant and nonanticoagulant actions" developed over the past 20 years and focused on this topic has published research data in three issues of Seminars in Thrombosis & Hemostasis and in several other international scientific journals. The latest developments on the methods of analysis, the synthesis, the degradation by heparanases and the nonanticoagulant effects in tumor growth, in anti-inflammatory diseases, and in Alzheimer diseases as presented in the 21st symposium are summarized in the present overview on the occasion of the 40th anniversary of the journal with special reference to the journal's founding Editor in Chief, Eberhard F. Mammen.

Measurement of rivaroxaban and apixaban in serum samples of patients.

BACKGROUND: The determination of rivaroxaban and apixaban from serum samples of patients may be beneficial in specific clinical situations when additional blood sampling for plasma and thus the determination of factor Xa activity is not feasible or results are not plausible. MATERIALS AND METHODS: The primary aim of this study was to compare the concentrations of rivaroxaban and apixaban in serum with those measured in plasma. Secondary aims were the performance of three different chromogenic methods and concentrations in patients on treatment with rivaroxaban 10 mg od (n = 124) or 20 mg od (n = 94) or apixaban 5 mg bid (n = 52) measured at different time. RESULTS: Concentrations of rivaroxaban and apixaban in serum were about 20-25% higher compared with plasma samples with a high correlation (r = 0·79775-0·94662) using all assays (all P < 0·0001). The intraclass correlation coefficients were about 0·90 for rivaroxaban and 0·55 for apixaban. Mean rivaroxaban concentrations were higher at 2 and 3 h compared with 1 and 12 h after administration measured from plasma and serum samples (all P-values < 0·05) and were not different between 1 vs. 12 h (plasma and serum). CONCLUSIONS: The results indicate that rivaroxaban and apixaban concentrations can be determined specifically from serum samples.

Concept of a point of care test to detect new oral anticoagulants in urine samples.

New oral anticoagulants (NOAC) are approved for several indications for prophylaxis and treatment of venous thromboembolism and for prevention of embolism in atrial fibrillation at fixed daily doses without need of laboratory guided dose adjustment. Due to their low molecular weight of about 500 to 600 Dalton and their hydrophilicity free anticoagulant is excreted immediately through glomerular filtration into the urine. Impairment of renal function may increase the plasma concentration of the anticoagulants and lowered creatinine clearance is a declared contraindication. In contrast to the initial aim of development the anticoagulant effect is required to be determined in special clinical situations. Several specific and non-specific assays using plasma samples are currently undergoing standardization. As all NOACs are excreted into the urine, specific assays were developed for this matrix to determine them quantitatively of qualitatively. Urine samples can be easily and repetitively obtained avoiding problems and risks associated with blood sampling. The qualitative assay can be performed as a point of care test (POC) also by the patient by judging the different colours for the absence or presence of the drugs with the naked eye. The test is rapid (results available within 15 min), sensitive, specific and accurate and does not require a purified NOAC as control. The tests may be a tool for clinicians who need to know for treatment decisions if a NOAC is on board or not. As the tests are specific for oral direct thrombin inhibitors and for oral direct factor Xa inhibitors, the indication does not interfere with other qualitative POC test in development using clotting systems. The test may be indicated for patients at acute hospitalization, before surgery or central nervous system puncture anaesthesia, if fibrinolytic therapy is indicated, acute deterioration of renal function, and for control of adherence to therapy.

Novel methods for assessing oral direct factor Xa and thrombin inhibitors: use of point-of-care testing and urine samples.

Rivaroxaban and dabigatran are new oral anticoagulants (NOACs) that inhibit directly factor Xa and thrombin, respectively. These NOACs effectively prevent thromboembolic complications using fixed doses without the need for dose adjustment according to laboratory results. About 60% of rivaroxaban is cleared from circulation by glomerular filtration, 30% of which is excreted as active drug. About 80% of dabigatran is excreted into urine as active compound. Accordingly, both NOACs can be determined in urine by means of chromatographic methods. Only a few laboratories are able to perform such methods, and results are not available within short time frames. New methods have to be developed to obtain results within minutes and possibly as point-of-care (POC) techniques. This testing may be useful for special patient populations such as those with acute deterioration of renal function due to any disease, before surgical interventions, during unexpected bleeding or thrombotic episodes while on therapy with NOACs, the oldest and youngest populations, pregnancy, suspicion of overdose and intoxication, and to determine adherence to therapy. Here we describe results of a POC qualitative assay using urine samples from patients on treatment with dabigatran and rivaroxaban.

Sporadic adenocarcinoma of the colon in children: case series and review of the literature.

BACKGROUND: Adenocarcinoma of the colon is rare in pediatric patients and thus not much is known about its clinical and imaging characteristics. OBSERVATIONS: We present 4 adolescents with an average age of 15 years who present with several month histories of significant weight loss and abdominal pain. All had an abdominal and pelvic computed tomography scan, which revealed an adenocarcinoma in the colon. One patient had metastatic disease at diagnosis. The main treatment was primary resection and chemotherapy. Two of the children had a family history of colon cancer. Our case series depicts similarities and differences in disease presentation, tumor location, pattern of metastasis, genetics, management between adults and children and conducts a review of the relevant literature concerning adenocarcinoma in the pediatric population. CONCLUSIONS: In children, this disease has more aggressive histologies and presents more frequently in an advanced stage. This is because it is not a diagnosis often considered, leading to poorer outcomes. When patients present in the correct clinical context, the possibility of colonic adenocarcinoma should be considered in the differential diagnosis, which may in turn lead to better outcomes.

Low-dose fetal CT for evaluation of severe congenital skeletal anomalies: preliminary experience.

Congenital skeletal abnormalities compose a heterogeneous and complex group of conditions that affect bone growth and development and result in various anomalies in shape and size of the skeleton. Prenatal sonographic diagnosis of these anomalies is challenging because of the relative rarity of each skeletal dysplasia, the multitude of differential diagnoses encountered when the bony abnormalities are identified, lack of precise molecular diagnosis and the fact that many of these disorders have overlapping features and marked phenotypic variability. The following review is a preliminary summary of our experience at the Children's Hospital of Philadelphia (CHOP) using low-dose fetal CT in the evaluation of severe fetal osseous abnormalities.

Extrafetal findings at fetal MR: evaluation of the normal placenta and correlation with ultrasound.

Despite the increasing use of magnetic resonance (MR) for fetal imaging, few studies have addressed the MR appearance of the normal placenta. The goal of this paper is to describe the MR features and thickness of the normal placenta during the second and early third trimester of gestation, based on a retrospective study comparing MR with the reference standard of obstetric imaging, ultrasound.

MR evaluation of fetal demise.

BACKGROUND: Fetal demise is an uncommon event encountered at MR imaging. When it occurs, recognition by the interpreting radiologist is important to initiate appropriate patient management. OBJECTIVE: To identify MR findings of fetal demise. MATERIALS AND METHODS: Following IRB approval, a retrospective search of the radiology fetal MR database was conducted searching the words "fetal demise" and "fetal death." Fetuses with obvious maceration or no sonographic confirmation of death were excluded. Eleven cases formed the study group. These were matched randomly to live fetuses of similar gestational age. Images were reviewed independently by three pediatric radiologists. RESULTS: The deceased fetus demonstrates decreased MR soft-tissue contrast and definition of tissue planes, including loss of gray-white matter differentiation in the brain. The signal within the cardiac chambers, when visible, is bright on HASTE sequences from the stagnant blood; the heart is small. Pleural effusions and decreased lung volumes may be seen. Interestingly, the fetal orbits lose their anatomical round shape and become smaller and more elliptical; a dark, irregular rim resembling a mask may be seen. CONCLUSION: Although fetal demise is uncommonly encountered at MR imaging, radiologists should be aware of such imaging findings so prompt management can be instituted.

Effectiveness of a liaison program in meeting information needs of college of pharmacy faculty.

This article describes the creation and implementation of focus groups to evaluate the effectiveness of a health sciences library's liaison program of the College of Pharmacy faculty and to better understand the faculty's information needs in order to design new and improved library services. The liaison services support the teaching and research needs of faculty and students through literature research, classroom teaching, and an extensive library collection of pharmacy literature. Focus group results demonstrated a high level of satisfaction with library liaison services and collections. Opportunities exist for expanded interaction with graduate students and greater marketing of library services to increase faculty awareness of specific library programs.

US pharmacists' effect as team members on patient care: systematic review and meta-analyses.

BACKGROUND: One approach postulated to improve the provision of health care is effective utilization of team-based care including pharmacists. OBJECTIVE: The objective of this study was to conduct a comprehensive systematic review with focused meta-analyses to examine the effects of pharmacist-provided direct patient care on therapeutic, safety, and humanistic outcomes. METHODS: The following databases were searched from inception to January 2009: NLM PubMed; Ovid/MEDLINE; ABI/INFORM; Health Business Fulltext Elite; Academic Search Complete; International Pharmaceutical Abstracts; PsycINFO; Cochrane Database of Systematic Reviews; National Guideline Clearinghouse; Database of Abstracts of Reviews of Effects; ClinicalTrials.gov; LexisNexis Academic Universe; and Google Scholar. Studies selected included those reporting pharmacist-provided care, comparison groups, and patient-related outcomes. Of these, 56,573 citations were considered. Data were extracted by multidisciplinary study review teams. Variables examined included study characteristics, pharmacists' interventions/services, patient characteristics, and study outcomes. Data for meta-analyses were extracted from randomized controlled trials meeting meta-analysis criteria. RESULTS: A total of 298 studies were included. Favorable results were found in therapeutic and safety outcomes, and meta-analyses conducted for hemoglobin A1c, LDL cholesterol, blood pressure, and adverse drug events were significant (P < 0.05), favoring pharmacists' direct patient care over comparative services. Results for humanistic outcomes were favorable with variability. Medication adherence, patient knowledge, and quality of life-general health meta-analyses were significant (P < 0.05), favoring pharmacists' direct patient care. CONCLUSIONS: Pharmacist-provided direct patient care has favorable effects across various patient outcomes, health care settings, and disease states. Incorporating pharmacists as health care team members in direct patient care is a viable solution to help improve US health care.

Esophageal obstruction and intracardiac "mass" in association with omphalocele closure.

Patients with large omphaloceles are subject to anatomical displacement and morphological distorsion after surgical repair. We report 2 such complications in an infant after repair of a giant omphalocele that contained both liver and bowel. Esophageal obstruction resulted from sharp, anterior angulation of the distal esophagus that hindered placement of a feeding tube in the neonatal period. At 1 year of age, routine cardiac evaluation led to the discovery of a "mass" within the heart caused by invagination of a tongue of liver tissue into the right atrium. Knowledge of these less well-recognized anatomical variations is important to avoid unnecessary interventions.