Subject(s)
Fungemia/diagnosis , Liver Failure/immunology , Tinea/diagnosis , Trichophyton/isolation & purification , Adult , Antifungal Agents/therapeutic use , Biopsy, Needle , Exanthema/complications , Exanthema/diagnosis , Follow-Up Studies , Fungemia/complications , Fungemia/drug therapy , Fungemia/immunology , Humans , Immunocompromised Host , Immunohistochemistry , Liver Failure/complications , Liver Failure/diagnosis , Male , Risk Assessment , Tinea/complications , Tinea/drug therapy , Tinea/immunologyABSTRACT
PURPOSE: A diffuse exanthema in a patient receiving varenicline is reported. SUMMARY: A 71-year-old white woman, who was initially admitted to the hospital for elective vascular bypass surgery, had a three-day history of a diffuse rash, severe itching, and moderate headache. Her symptoms started two days before her admission. She denied having a fever, chills, nausea, vomiting, diarrhea, and flulike symptoms. She also denied having had contact with anyone who was ill, tick or insect bites, exposure to cats, or any changes in her diet, habits, or personal hygiene. Her medical problems included peripheral vascular disease, chronic obstructive pulmonary disease (COPD), dyslipidemia, hypertension, and hypothyroidism. In addition to several medications she had been taking for over 2 years, she had been taking varenicline as an aid for smoking cessation for eight days. The patient had been smoking for 40 years. The bright-red rash covered 70% of her torso and four extremities. She had mild swelling in her cheeks, but not on the eyelids or lips. Both of her lungs were clear on auscultation, with distant breath sounds caused by her COPD. Varenicline was discontinued, and her symptoms had completely resolved by the eighth day following discontinuation of the medication. While it is possible that other medications caused her symptoms, she had been taking most of them for over 2 years and all of them for over 1 year. Also, continuation of these drugs did not prevent her symptoms from resolving, nor did it cause a recurrence of the skin reaction. CONCLUSION: A patient developed diffuse exanthema after being treated with varenicline.
Subject(s)
Benzazepines/adverse effects , Exanthema/chemically induced , Nicotinic Agonists/adverse effects , Quinoxalines/adverse effects , Aged , Benzazepines/administration & dosage , Exanthema/physiopathology , Female , Humans , Nicotinic Agonists/administration & dosage , Quinoxalines/administration & dosage , Smoking Cessation , VareniclineSubject(s)
Pharmacists , Professional Competence , Communication , Decision Making , Humans , Knowledge , Patient Education as Topic , Problem SolvingABSTRACT
OBJECTIVES: [corrected] To develop guidelines for the documentation elements that need to be included in any record of pharmacist-provided care to allow the quality of the care to be assessed and to describe the use of these guidelines to improve the quality of pharmacist documentation. DESIGN: An initial list of 85 potential documentation elements, developed through a review of the literature, was validated by a group of pharmacy practitioners. Then, through three rounds of a Delphi process and a group meeting, a panel of experts reached consensus on a refined list of 27 documentation data elements. RESULTS: The documentation elements were formatted into a one-page Tool for Evaluation of Documentation (TED). The TED is a checklist for assessing the completeness of the documentation of pharmacist-provided care. CONCLUSION: The TED and the consensus-building methodology used in the development of this tool can serve as cornerstones of a quality assessment process for documentation of pharmacist-provided care, enable further assessment of the quality of care, and, ultimately, be used to measure the impact of pharmacist-provided care on patient outcomes. Our results should provide guidance both to pharmacists providing care and to organizations that assess the quality of that care.
Subject(s)
Documentation , Pharmaceutical Services/standards , Quality Assurance, Health Care/methods , Delphi Technique , Humans , Practice Guidelines as Topic , United StatesABSTRACT
OBJECTIVES To develop guidelines for the documentation elements that need to be included in any record of pharmacist-provided care to allow the quality of the care to be assessed and to describe the use of these guidelines to improve the quality of pharmacist documentation. DESIGN An initial list of 85 potential documentation elements, developed through a review of the literature, was validated by a group of pharmacy practitioners. Then, through three rounds of a Delphi process and a group meeting, a panel of experts reached consensus on a refined list of 27 documentation data elements. RESULTS The documentation elements were formatted into a one-page Tool for Evaluation of Documentation (TED). The TED is a checklist for assessing the completeness of the documentation of pharmacist-provided care. CONCLUSION The TED and the consensus-building methodology used in the development of this tool can serve as cornerstones of a quality assessment process for documentation of pharmacist-provided care, enable further assessment of the quality of care, and, ultimately, be used to measure the impact of pharmacist-provided care on patient outcomes. Our results should provide guidance both to pharmacists providing care and to organizations that assess the quality of that care.
ABSTRACT
The dissected tooth bearing bones of 20 specimens of Amia calva (Pisces:Holostei) ranging from the third to tenth season have been examined radiographically and in alizarin red S stained and cleared specimens. Although forms of alternate (1:1) tooth series replacement (sensu Edmund, '60) were frequently observed, even in the youngest, immature specimens, many examples of irregular replacement were recorded. In several bones, the maxillae in particular, series with every third (2:1) or fourth (3:1) tooth replacing were seen and possible patterns of 2:2, were recorded. It is concluded that these data are not consistent with the Zahnreihen concept but support a morphogenic field concept of tooth development.