Strategies for success in creating an effective multihospital health-system pharmacy and therapeutics committee.

PURPOSE: Lessons learned from the creation of a multihospital health-system formulary management and pharmacy and therapeutics (P&T) committee are described. SUMMARY: A health system can create and implement a multihospital system formulary and P&T committee to provide evidence-based medications for ideal healthcare. The formulary and P&T process should be multidisciplinary and include adequate representation from system hospitals. The aim of a system formulary and P&T committee is standardization; however, the system should allow flexibility for differences. Key points for a successful multihospital system formulary and P&T committee are patience, collaboration, resilience, and communication. When establishing a multihospital health-system formulary and P&T committee, the needs of individual hospitals are crucial. A designated member of the pharmacy department needs to centrally coordinate and manage formulary requests, medication reviews and monographs, meeting agendas and minutes, and a summary of decisions for implementation. It is imperative to create a timeline for formulary reviews to set expectations, as well as a process for formulary appeals. Collaboration across the various hospitals is critical for successful formulary standardization. When implementing a health-system P&T committee or standardizing a formulary system, it is important to be patient and give local sites time to make practice changes. Evidence-based data and rationale must be provided to all sites to support formulary changes. Finally, there must be multidisciplinary collaboration. CONCLUSION: There are several options for formulary structures and P&T committees in a health system. Potential strengths and barriers should be evaluated before selecting a formulary management process.

Understanding the role of tissue degrading enzymes and their inhibitors in development and disease.

Cartilage and the underlying bone are destroyed in severe cases of arthritis preventing joints from functioning normally. Cartilage and bone collagen can be specifically cleaved by the collagenases, members of the matrix metalloproteinase family (MMPs), whilst cartilage aggrecan is degraded by members of the ADAMTS (A Disintegrin And Metalloproteinase with ThromboSpondin repeats) family of proteinases. Intracellular cysteine proteinases are involved in bone resorption by osteoclasts and the serine proteinases are involved in activating MMPs. Together, these enzymes act in concert during normal growth and development, especially within the growth plate; however they are also involved in tissue destruction during disease. Synthetic MMP inhibitors have been investigated as a means to block tissue destruction in arthritis but have been unsuccessful, although recent trials with doxycycline suggest this may block joint destruction in osteoarthritis. It is likely that combinations of therapy will be required to ensure that joint destruction is prevented in arthritis patients.

Polyradiculopathy and herpes zoster.

Herpes zoster causing skin eruptions and neuropathic pain is routinely seen in the clinical setting. We present an interesting case of weakness involving more than one nerve root level secondary to shingles. The differential diagnosis of lower extremity weakness is long. While a polyradiculopathy secondary to herpes zoster infection is rare, it must be considered in a patient with dermatomal involvement. A thorough history and physical examination with appropriate diagnostic testing is essential to establish the correct diagnosis and thus the appropriate treatment. We present a retrospective review of a case of polyradiculopathy secondary to herpes zoster infection.

A pragmatic and readily implemented quality control strategy for HPLC-MS and GC-MS-based metabonomic analysis.

Metabonomic/metabolomic studies can involve the analysis of large numbers of samples for the detection of biomarkers and confidence in the analytical data, generated by methods such as GC and HPLC-MS, requires active measures on the part of the analyst. However, quality control for complex multi-component samples such as biofluids, where many of the components of interest in the sample are unknown prior to analysis, poses significant problems. Here the repeat analysis of a pooled sample throughout the run, thereby enabling the analysis to be monitored and controlled using targeted inspection of the data and pattern recognition, is advocated as a pragmatic solution to this problem.

A metabonomic analysis of plasma from Zucker rat strains using gas chromatography/mass spectrometry and pattern recognition.

Plasma obtained from three strains of Zucker rats was analysed using capillary gas chromatography/mass spectrometry (GC/MS) to obtain global metabolite profiles as part of a series of metabonomic investigations of animal models of diabetes. Samples were obtained from 20-week-old male wild-type Zucker lean, (fa/fa) obese and lean/(fa) animals and were analysed following protein precipitation, using acetonitrile, and derivatisation. Subsequent data analysis using principal components analysis (PCA) and orthogonal projection to latent structures (OPLS) revealed differences between the plasma metabolite profiles of the three strains, with those of the Zucker lean and the lean/(fa) crosses being similar to each other whilst differing from the (fa/fa) obese strain.