A prospective cohort study of medication reconciliation using pharmacy technicians in the emergency department to reduce medication errors among admitted patients.

BACKGROUND: The collection of a complete, verified medication history is essential to patient safety. The involvement of clinical pharmacists has been shown to improve the completeness and accuracy of medication histories; however, to our knowledge, involvement of pharmacy technicians has not been studied. OBJECTIVE: Our aim was to determine whether verification of medication histories by pharmacy technicians in the emergency department (ED) would result in fewer errors in inpatient medication regimens compared to verification by the admitting physician team. METHODS: We performed a prospective cohort study of adult ED patients admitted for continuing care. In the intervention group, medication reconciliation was performed by pharmacy technicians in the ED before the creation of physician admitting orders. In the control group, pharmacy technicians conducted their history taking later, after admission. Initial admitting orders were then compared to the pharmacy technicians' medication reconciliation taken before admission (intervention group) or after admission (control group). Medication discrepancies were classified and determined to be justified or unjustified. Unjustified discrepancies were rated for harm potential. RESULTS: In our cohort of 113 intervention and 75 control subjects, the mean age was 55 years (standard deviation [SD] 16 years); 96 patients (51%) were male. In the intervention group, 566 changes to home medications were observed on admission; 352 (62%) were unjustified. Among controls, 406 changes to home medications were observed; 228 (56%) were unjustified. This difference was not statistically significant (p = 0.0586). The rate of unjustified medication changes per patient was likewise not significantly different (3.14 [SD 2.98] in interventions vs. 3.17 [SD 2.81] in controls; p = 0.9570). The rate of medical errors did not differ between study groups, nor did severity ratings of unjustified changes. CONCLUSIONS: Medication reconciliation by pharmacy technicians in the ED did not lead to a significant reduction in unjustified medication discrepancies.

Directed flow at midrapidity in sqrt[S(NN)] = 2.76 TeV Pb + Pb collisions.

We analyze published data from the ALICE Collaboration in order to obtain the first extraction of the recently proposed rapidity-even directed flow observable v(1). An accounting of the correlation due to the conservation of transverse momentum restores the factorization seen by ALICE in all other Fourier harmonics and thus indicates that the remaining correlation gives a reliable measurement of directed flow. We then carry out the first viscous hydrodynamic calculation of directed flow, and show that it is less sensitive to viscosity than higher harmonics. This allows for a direct extraction of the dipole asymmetry of the initial state, providing a strict constraint on the nonequilibrium dynamics of the early-time system. A prediction is then made for v(1) in Au-Au collisions at RHIC.

Anisotropic flow in event-by-event ideal hydrodynamic simulations of √[s(NN)]=200 GeV Au+Au collisions.

We simulate top-energy Au+Au collisions using ideal hydrodynamics in order to make the first comparison to the complete set of midrapidity flow measurements made by the PHENIX Collaboration. A simultaneous calculation of v(2), v(3), v(4), and the first event-by-event calculation of quadrangular flow defined with respect to the v(2) event plane (v(4){Ψ(2)}) gives good agreement with measured values, including the dependence on both transverse momentum and centrality. This provides confirmation that the collision system is indeed well described as a quark-gluon plasma with an extremely small viscosity and that correlations are dominantly generated from collective effects. In addition, we present a prediction for v(5).

Directed flow at midrapidity in heavy-ion collisions.

It was recently shown that fluctuations in the initial geometry of a heavy-ion collision generally result in a dipole asymmetry of the distribution of outgoing particles. This asymmetry, unlike the usual directed flow, is expected to be present at a wide range of rapidity--including midrapidity. The first evidence of this phenomenon can be seen in recent two-particle correlation data by the STAR Collaboration, providing the last element necessary to quantitatively describe long-range dihadron correlations. We extract differential directed flow from these data and propose a new direct measurement.

Catheter-Associated Urinary Tract Infection, Clostridioides difficile Colitis, Central Line-Associated Bloodstream Infection, and Methicillin-Resistant Staphylococcus aureus.

Hospital-acquired infections increase cost, morbidity, and mortality for patients across the United States and the world. Principal among these infections are central line-associated bloodstream infection, catheter-associated urinary tract infection, Clostridioides difficile, and methicillin-resistant Staphylococcus aureus colonization and infections. This article provides succinct summaries of the background, epidemiology, diagnosis, and treatment of these conditions. In addition, novel prevention strategies, including those related to recent national interventions, are reviewed.

Viscous hydrodynamic predictions for nuclear collisions at the LHC.

Hydrodynamic simulations are used to make predictions for the integrated elliptic flow coefficient v2 in square root(s) = 5.5 TeV lead-lead and square root(s) = 14 TeV proton-proton collisions at the LHC. We predict a 10% increase in v2 from RHIC to Pb+Pb at LHC, and v2 approximately 0 in p+p collisions unless eta/s<0.08.