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Int J Pharm Pract ; 24(2): 134-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26450649


OBJECTIVES: Accreditation guidelines in the USA suggest that experiential sites for pharmacy students should demonstrate 'a strong commitment to health promotion and illness prevention'; however, most community pharmacies sell tobacco products. This study aimed to determine the proportion of students rotating through advanced pharmacy practice experience (APPE) sites where tobacco is sold and experiential education directors' perception regarding the sales of tobacco in APPE sites. METHODS: A brief survey was distributed by mail to experiential education directors at US pharmacy schools. The survey characterized the proportion of students who rotate at practice sites where tobacco is sold, directors' perceptions of tobacco sales in experiential sites, and the number of hours of tobacco education in their pharmacy curricula. KEY FINDINGS: Directors (n = 81; 63%) estimated that 69% of students rotate through sites where tobacco is sold. If given the opportunity to choose between two potential sites, where one sells tobacco and the other does not, 40% of directors would be unlikely to choose a site that sold tobacco. CONCLUSIONS: With respect to tobacco sales, pharmacy schools are largely noncompliant with guidelines and resolutions of professional organizations.

Atitude do Pessoal de Saúde , Educação em Farmácia/organização & administração , Fidelidade a Diretrizes/estatística & dados numéricos , Farmácias , Faculdades de Farmácia/organização & administração , Produtos do Tabaco , Acreditação/normas , Comércio , Currículo/normas , Promoção da Saúde/métodos , Humanos , Aprendizagem Baseada em Problemas , Estudantes de Farmácia , Inquéritos e Questionários , Estados Unidos
Crit Care ; 15(4): R167, 2011 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-21749683


INTRODUCTION: Adequate ventilatory support of critically ill patients depends on prompt recognition of ventilator asynchrony, as asynchrony is associated with worse outcomes.We compared an automatic method of patient-ventilator asynchrony monitoring, based on airway flow frequency analysis, to the asynchrony index (AI) determined visually from airway tracings. METHODS: This was a prospective, sequential observational study of 110 mechanically ventilated adults. All eligible ventilated patients were enrolled. No clinical interventions were performed. Airway flow and pressure signals were sampled digitally for two hours. The frequency spectrum of the airway flow signal, processed to include only its expiratory phase, was calculated with the Cooley-Tukey Fast Fourier Transform method at 2.5 minute intervals. The amplitude ratio of the first harmonic peak (H1) to that of zero frequency (DC), or H1/DC, was taken as a measure of spectral organization. AI values were obtained at 30-minute intervals and compared to corresponding measures of H1/DC. RESULTS: The frequency spectrum of synchronized patients was characterized by sharply defined peaks spaced at multiples of mean respiratory rate. The spectrum of asynchronous patients was less organized, showing lower and wider H1 peaks and disappearance of higher frequency harmonics. H1/DC was inversely related to AI (n = 110; r2 = 0.57; P < 0.0001). Asynchrony, defined by AI > 10%, was associated H1/DC < 43% with 83% sensitivity and specificity. CONCLUSIONS: Spectral analysis of airway flow provides an automatic, non-invasive assessment of ventilator asynchrony at fixed short intervals. This method can be adapted to ventilator systems as a clinical monitor of asynchrony.

Monitorização Fisiológica/métodos , Mecânica Respiratória/fisiologia , Ventiladores Mecânicos/normas , Idoso , District of Columbia , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Respiração Artificial/métodos
Intensive Care Med ; 34(9): 1662-8, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18542920


OBJECTIVE: Blood O(2) saturation and lactate concentration gradients from superior vena cava (SVC) to pulmonary artery (PA) occur in critically ill patients. These gradients (DeltaSO(2) and Delta[Lac]) may be positive or negative. We tested the hypothesis that positive DeltaSO(2) and Delta[Lac] are associated with improved survival in critically ill patients. DESIGN AND SETTING: Multinational, prospective observational study conducted in six medical and surgical ICUs. PATIENTS: Consecutive sample of 106 adults requiring insertion of a pulmonary artery catheter (PAC). Average age was 59.5 +/- 15.5 years, APACHE II score was 15.5 +/- 6.7 (mean +/- SD). Main outcome measure was 28-day mortality. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: We drew blood samples from the proximal and distal ports of PACs every 6 h from the time of PAC insertion (Initial measurement) until its removal (Final measurement). Samples were analyzed for SO(2), [Lac], glucose concentration and blood gases. Hemodynamic measurements were obtained after blood samples. We monitored patients for 30.9 +/- 11.0 h. Overall mortality rate was 25.5%. More survivors had mean and final DeltaSO(2) > or = 0 and Delta[Lac] > or = 0 than decedents (p < 0.01; p < 0.05 respectively). On the average, DeltaSO(2) and Delta[Lac] were positive in survivors and negative in decedents. Survival odds ratios for final measurements of DeltaSO(2) > or = 0 and Delta[Lac] > or = 0 were 19.22 and 7.70, respectively (p < 0.05). CONCLUSIONS: A strong association exists between positive DeltaSO(2) and Delta[Lac] and survival in critically ill patients. Whether therapy aimed at increasing DeltaSO(2) and Delta[Lac] results in improved ICU survival remains to be determined.

Estado Terminal/mortalidade , Lactatos/sangue , Oxigênio/sangue , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/mortalidade , Sepse/sangue , Sepse/mortalidade , APACHE , Cateterismo Venoso Central , Estado Terminal/classificação , Feminino , Hemodinâmica , Humanos , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Análise de Sobrevida
Chest ; 127(5): 1852-4, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15888869


This report describes the occurrence of solitary fibrous tumors of the pleura in a mother and her daughter. No other occurrence of this rare tumor in members of the same family has ever been reported.

Neoplasias de Tecido Fibroso/genética , Neoplasias Pleurais/genética , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias de Tecido Fibroso/diagnóstico por imagem , Neoplasias de Tecido Fibroso/cirurgia , Pleura/patologia , Neoplasias Pleurais/diagnóstico por imagem , Neoplasias Pleurais/cirurgia , Tomografia Computadorizada por Raios X