Medication reconciliation in a community pharmacy setting.

OBJECTIVES: To describe the types and frequencies of medication discrepancies identified through medication reconciliation in a community pharmacy setting, to identify potential correlations between a patient's electronic medical record (EMR) and pharmacy medication list, and to determine the relationship between patients who use prescribers and/or pharmacies outside of the Family Medicine Center (FMC) and the occurrence of medication discrepancies. METHODS: Cross-sectional comparison of patients' EMR medication lists and pharmacy medication fill history for a sample of patients presenting to the Family Medicine Pharmacy (FMP), which is located in the FMC on the University of Oklahoma Health Sciences Center campus in Oklahoma City. Discrepancies identified were classified according to one of six categories that included therapeutic duplication, medication exclusion, medications that should be designated inactive in the EMR medication list, and differences in medication strength, dosage form, or dosing regimen. RESULTS: A total of 100 patients were included. Most patients reported having all of their medications dispensed from FMP (89%), and most patients had prescriptions prescribed by FMC physicians only (57%). Each patient had an average of six medication discrepancies. Most discrepancies belonged to the inactive medication category (41%). The correlation between patients' FMP medication lists and their EMR medication lists was 0.73. Patients with one or more non-FMC prescribers had a greater number of medication discrepancies than patients with FMC prescribers only, but this relationship was not identified for those who used pharmacies outside of FMP (P = 0.0264 and 0.2580, respectively). CONCLUSION: A variety of medication discrepancies were observed, signaling a need for medication reconciliation in the outpatient setting. Future research on this topic should focus on the implications of such discrepancies in the outpatient setting, interventions to reduce the number of discrepancies, and identifying patients at high risk for such discrepancies.

Effect of aqueos neem leaf extract on blood pressure in conscious Wistar rats (a preliminary report)[abstract]

OBJECTIVE: This work investigates the effects of aqeous neem leaf extract on blood pressure (systolic, diastolic, and mean arterial pressure), heart rate and body weight in conscious Wistar rats. METHODS: The rats were divided into three groups of six. The first group received a daily intra-oesophageal bolus of 0.5 ml water. The 2nd and 3rd were given 20 mg/kg and 40 mg/kg body weight, respectively, of aqeous neem leef extract. Blood pressures and heart rate were measured using the LE 5002 Stroage Pressure meter (Letica Scientific Instruments). Body weight was also measured weekly for eight weeks. Statistical analysis was carried out using SPSS. RESULTS: Blood pressure, heart rate and body rate were not statistically different between the three groups on day 1. By week 8, the diastolic and mean arterial pressures wre significantly lower (p<0.0001) in the two neem-treated groups than in the controls. There was also no significant difference in weight between the groups. CONCLUSION: The results show that administration of o 20 mg/kg-body weight of aqeuous neem leaf extract reduces diastoloc and mena arterial blood pressures in conscious rats (AU)

Effects of hormone replacement therapy on mesolimbic extracellular dopamine stress: an in vivo microdialysis study

OBJECTIVE: To determine the effects of hormone replacement therapy on dopamine (DA) release in the nucleus accumbens septi (NAS) of rats following footshock stress and to correlate these effects with locomotory behaviour. DESIGN AND METHODS: Thirty-two Long Evans rats were ovariectomized and treated with oestradiol benzoate, progesterone or oil (control group). Rats were stereotaxically implanted with guide cannulae in the NAS and dialysis probes used to sample the extra-cellular fluid (ECF). Following baseline measurements, intermittent footshocks were delivered for 10 minutes, and dialysate DA levels and locomotor activity assessed over 20 minute intervals for 2 hours by high performance liquid chromatography and a photocell activity monitor, respectively. RESULTS: At baseline, hormone replacement significantly decreased DA levels in the NAS. Oestrogen treated rats had the lowest DA release at baseline (p<0.001). Following footshock, all groups exhibited significant increases in DA levels; oestrogen treated rats showed the most significant relative increase, but absolute levels remained lowest. Locomotor activity at baseline was highest in oestrogen treated rats and showed no change after footshock, remaining higher than in other groups. All other groups showed relative increase in activity after footshock (p=0.02). CONCLUSIONS: Oestrogen pre-treatment depresses baseline DA level in the NAS, but enhances relative levels after footshock, while suppressing changes in locomotor activity. There is a general reciprocal relationship between DA levels within ECF and locomotor activity in all groups. This finding may have implications for understanding of the processes regulated by NAS dopamine, e.g. addiction or associative learning.(Au)

Hormonal variations influences learning - abstract

The study attempted to evaluate the influence of hormonal status (gender and oestrous cycle) on learning in male and female rats and to determine whether this difference was affected by dopamine agonists (cocaine and amphetamine). Rats were exposed to foot-shocks in a Y-maze. Exploratory and avoidance behaviours were tested on two trials, 24 hours following conditioning (Trial 1) and 2 weeks subsequently (Trial 2). Amphetamine (1mg/kg/ml) stimulated exploratory behaviour, whereas cocaine (1mg/kg/ml) had a depressant effect at Trial 1. Avoidance learning of a potentially dangerous environment was significantly less in oestrous than in diestrous and male rats. These results provide evidence that hormonal status influences learning. Cocaine and amphetamine given in a single low doses did not produce any significant effects on avoidance learning(AU)

Children with lower birthweight have higher forearm vascular resistance - abstract

Undernutrition in utero is associated with the development of hypertension in rat models, as well as in man. The nature of this association remains unclear. The aim of the present study was to determine the effect of pregnancy programming on blood pressure and forearm blood flow in children. Subjects were randomly selected from the upper, middle and lowest quintiles of a distribution based on their birthweights. There were no significant differences in anthropometry and resting indices of cardiovascular response. Children were tested, using cold pressor test (CT) and mental arithmetic (M). Thus children in the lowest quintile of this population experienced greater change in FVR and FBF to the cold pressor test than their counterparts in the middle and upper quintiles. They also showed greater changes in SBP, HR, and RPP with mental arithmetic testing. Children in the middle and lower quintiles had higher SBP to the cold pressor test. The results demonstrate that children in the lowest quintile of this population have increased cardiovascular reactivity to standard laboratory stressors - table included (AU)

Trichuris trichiura elicits a secretory response in infected children - abstract

Trichuriasis occurs in children infected with the tropical helminth Trichuris trichiura. The children usually present with various clinical symptoms such as diarrhoea, stunting, and finger clubbing along with anaemia. An investigation was carried out to determine the mechanism of the watery diarrhoea observed during infection which ceased upon expulsion of the worms. A hypothesis was proposed that the diarrhoea observed during the period of infection occurred as a result of the net secretion of chloride ions across the epithelium. This active secretion of chloride ions could be a consequence of the immunologically specific IgE antibody medicated response to antigens secreted by the helminth shown in previous studies. A preliminary determination of the concentration of the chloride ions in the stools of the infected children before and after treatment revealed a higher concentration of chloride ions in the stools collected before treatment. Rectal biopsies were clamped at zero voltage in Ussing chambers and challenged on the mucosal side with antigen derived from Trichuris trichiura. The short-circuit current, a measure of ion movement, was monitored. The specific chloride channel blocker, anthracene-9-carboxylic acid, and furosemide, a chloride pump blocker, were used to demonstrate that the secretory response to antigen was chloride ion mediated. The antihistamine, diphenhydramine hydrochloride, was used to demonstrate that histamine released from degranulating mast cells played an important role in the response. The viability of the biopsies was checked at the end of each experiment by challenging on the serosal side with acetylcholine chloride (AU)

Electrophysiological assessment of brain function in severe malnutrition

Brain function in severely malnourished children was assessed using computer analysis of electroencephalographic (EEG) responses to photic driving at different frequencies during slow-wave sleep. Percent power in the classical EEG broad-band domains was derived from temporo-occipital records. Ten malnourished infants (5 - 23 months) age and sex-matched with 10 healthy controls (CON), having no neurological involvement or previous malnutrition, were studied. The malnourished group was tested on admission (ADM) and on discharge (DIS) from hospital. The results revealed significant differences in the alpha 1 band for the undriven EEG, and in the alpha/beta 1 power ratio while driving at 8 Hz, between the malnourished and control groups. ADM and DIS groups did not differ significantly, but there was a significant trend towards reduction from ADM to DIS to CON. These findings indicate that in malnutrition (1) EEG measures can index the deviation of brain function from normality, and (2) physical properties relating to brain function remain abnormal despite anthropometric catch up. (AU)

Electrophysiological assessment of brain function in severe malnutrition - abstract

Brain function in severly malnourished children was assessed, using computer analysis of electroencephalographic (EEG) responses to photic driving at different frequencies during slow-wave sleep. Percentage power in the classical EEG broad-band domains was derived from temporo-occipital records. Ten malnourished infants (5 - 23 months), age and sex-matched with 10 healthy controls (CON), having no neurological involvement or previous malnutrition, were studied. The malnourished group was tested on admission (ADM) and on discharge (DIS) from hospital. A stronger mean peak response to photic driving for the narrow band spectra was observed for the malnourished group, but this difference did not attain a level of statistical significance. This observation indicates a reduced efficacy of inhibitory processes in the malnourished brain, a condition also observed in the brain of malnourished animals. Significant differences were, however, found in the alpha-1 band for the undriven EEG, and in the summed alpha/beta-1 power ratio while driving at 8 Hz, between the malnourished and control groups. ADM and DIS groups did not differ significantly in the trend towards reduction from ADM to DIS to CON. These findings indicate that, in malnutrition (1) EEG measures can index the deviation of brain function from normality, and (2) physical properties relating to brain function remain abnormal despite anthropometric catch-up (AU)

Bioelectrical-impedence analysis as a measure of body composition in a West Indian population

Percent body fat (percent BF) was estimated in 50 males and 50 females aged 8-21 y by using hydrodensitometry (percent BF) and a bioelectrical-impedance analyzer (percent BF-BIA). The sample population was racially heterogenous, though predominantly of African origin. Percent body fat was computed from density by using an equation derived specifically for blacks. The BIA predicted percent BF with r2 = 0.77 (SEE = 3.7 percent BF), underestimating by a mean of 1.7 percent BF. Residuals ( percent BFd - percent BF-BIA) were normally distributed but were significantly correlated with age (P less than 0.01), although this effect was small. The theoretical bases for impedance analysis and for hydrodensitometry would appear for different reasons to impair applicability of these techniques to the present population and age group. However, for our population sample the BIA estimated percent BF as precisely as other simple techniques applied to other populations. (AU)

Ultrastructural and neuropharmacological findings in the nerve/muscle system of a digenean (Cercaria caribbea LXXI Cable)

The surface morphology and organization of the neuromuscular system in Cercaria caribbea LXXI are investigated using scanning and transmission electron microscopy, respectively. Direct and indirect (sarconeural) nerve-muscle junctions are identified in the cercarial tail. Synaptic vesicles at the direct neuromuscular junction suggest cholinergic and aminoacidergic transmission. Those at the sarconeural junctions suggest catecholaminergic and/or serotonergic transmission. Acetylcholinesterase and non-specific cholinesterases were found in high concentrations in the proximal and distal tail. Flourescence histochemistry showed primary catecholamines and 5-HT in the body and tail. 5-HT in the tail may represent a slowly depleted store, perhaps associated with energy availability and utilization. (AU)

Photoreceptor evoked potentials and phototactic behaviour in cercaria caribbea LXXI cable

Transient potential changes evoked in response to light stimuli, and presumably arising from rhabdomeric eye-spots in the cercarial body, were recorded for the first time, to our knowledge, in helminth parasites. Pigmented Cercaria caribbea LXXI gave a very slowly adapting response to maintained light stimulus, while a non-pigmented variety appeared to emit a stronger, rapidly adapting response to light onset. Swimming towards a directional light source is disrupted by several neurophamacological agents, which presumably disturb synaptic transmission in the nerve/muscle system. The light evoked potentials were unaffected by these same agents and therefore, appeared to be directly recorded receptor potentials.(AU)

Computer-analysed EEG for monitoring cerebrovascular insufficiency - abstract

This report aims to show that computer analysis of the electroencephalogram (EEG) can greatly enhance and accelerate its diagnostic capability, permitting rapid, on-line detection of changes in cerebral cortical activity. We describe the use of the computer-analysed EEG to detect critical cerebral under-perfusion due to lowered systemic blood flow during cardiac bypass surgery. Such hypo-perfusion frequently results in post-operative neurological deficits. We demonstrate that computer-generated maps of the scalp distribution of percent power in the frequency band can indicate areas of critical cerebral cortical ischaemia sufficiently rapidly to allow raising of perfusion rate and reversal of functional deterioration before the onset of permanent damage. We show that computer-analysed EEG can detect abnormal levels of band activity within seconds after a drastic fall in systemic perfusion, indicating the "probability of abnormality" by performing a z-transform of the measured levels, against age-adjusted norms stored in the computer. We then introduce data indicating that the computer-analysed EEG, by combining several z-transformed EEG measures, can detect both symptomatic and asymptomatic cerebrovascular disease more effectively than the 133 Xe regional cerebral blood flow technique. Since cerebrovascular disease is a major cause of adult mortality and morbidity in the West Indies, this technique should be of great interest in the present context (AU)