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Cavanaugh J, Pinelli N, Eckel S, Gwynne M, Daniels R, Hawes EM. Advancing Pharmacy Practice through an Innovative Ambulatory Care Transitions Program at an Academic Medical Center. Pharmacy (Basel) 2020; 8:pharmacy8010040. [PMID: 32178259 PMCID: PMC7151695 DOI: 10.3390/pharmacy8010040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 11/16/2022] Open
Abstract
Hospital readmissions are common and often preventable, leading to unnecessary burden on patients, families, and the health care system. The purpose of this descriptive communication is to share the impact of an interdisciplinary, outpatient clinic-based care transition intervention on clinical, organizational, and financial outcomes. Compared to usual care, the care transition intervention decreased the median time to Internal Medicine Clinic (IMC) or any clinic follow-up visit by 5 and 4 days, respectively. By including a pharmacist in the hospital follow-up visit, the program significantly reduced all-cause 30-day hospital readmission rates (9% versus 26% in usual care) and the composite endpoint of 30-day health care utilization, which is defined as readmission and emergency department (ED) rates (19% versus 44% usual care). Over the course of one year, this program can prevent 102 30-day hospital readmissions with an estimated cost reduction of $1,113,000 per year. The pharmacist at the IMC collaborated with the Family Medicine Clinic (FMC) pharmacist to standardize practices. In the FMC, the hospital readmission rate was 6.5% for patients seen by a clinic-based pharmacist within 30 days of discharge compared to 20% for those not seen by a pharmacist. This transitions intervention demonstrated a consistent and recognizable contribution from pharmacists providing direct patient care and practicing in the ambulatory care primary care settings that has been replicated across clinics at our academic medical center.
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Affiliation(s)
- Jamie Cavanaugh
- Department of Medicine, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC 27599, USA;
- UNC Eshelman School of PharmacyChapel Hill, NC 27599, USA; (N.P.); (S.E.); (R.D.)
| | - Nicole Pinelli
- UNC Eshelman School of PharmacyChapel Hill, NC 27599, USA; (N.P.); (S.E.); (R.D.)
| | - Stephen Eckel
- UNC Eshelman School of PharmacyChapel Hill, NC 27599, USA; (N.P.); (S.E.); (R.D.)
- Department of Pharmacy, UNC Health, Chapel Hill, NC 27514, USA
| | - Mark Gwynne
- UNC Health Alliance, UNC Health, Morrisville, NC 27560, USA;
- Department of Family Medicine, UNC School of Medicine, Chapel Hill, NC 27599, USA
| | - Rowell Daniels
- UNC Eshelman School of PharmacyChapel Hill, NC 27599, USA; (N.P.); (S.E.); (R.D.)
- Department of Pharmacy, UNC Health, Chapel Hill, NC 27514, USA
| | - Emily M. Hawes
- UNC Eshelman School of PharmacyChapel Hill, NC 27599, USA; (N.P.); (S.E.); (R.D.)
- Department of Pharmacy, UNC Health, Chapel Hill, NC 27514, USA
- Department of Family Medicine, UNC School of Medicine, Chapel Hill, NC 27599, USA
- Correspondence: ; Tel.: +(984) 974-0210
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Lissauer D, Cheshire J, Dunlop C, Taki F, Wilson A, Smith JM, Daniels R, Kissoon N, Malata A, Chirwa T, Lwesha VM, Mhango C, Mhango E, Makwenda C, Banda L, Munthali L, Nambiar B, Hussein J, Williams HM, Devall AJ, Gallos I, Merriel A, Bonet M, Souza JP, Coomarasamy A. Development of the FAST-M maternal sepsis bundle for use in low-resource settings: a modified Delphi process. BJOG 2019; 127:416-423. [PMID: 31677228 PMCID: PMC7384197 DOI: 10.1111/1471-0528.16005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2019] [Indexed: 01/14/2023]
Abstract
Objective To develop a sepsis care bundle for the initial management of maternal sepsis in low resource settings. Design Modified Delphi process. Setting Participants from 34 countries. Population Healthcare practitioners working in low resource settings (n = 143; 34 countries), members of an expert panel (n = 11) and consultation with the World Health Organization Global Maternal and Neonatal Sepsis Initiative technical working group. Methods We reviewed the literature to identify all potential interventions and practices around the initial management of sepsis that could be bundled together. A modified Delphi process, using an online questionnaire and in‐person meetings, was then undertaken to gain consensus on bundle items. Participants ranked potential bundle items in terms of perceived importance and feasibility, considering their use in both hospitals and health centres. Findings from the healthcare practitioners were then triangulated with those of the experts. Main outcome measure Consensus on bundle items. Results Consensus was reached after three consultation rounds, with the same items deemed most important and feasible by both the healthcare practitioners and expert panel. Final bundle items selected were: (1) Fluids, (2) Antibiotics, (3) Source identification and control, (4) Transfer (to appropriate higher‐level care) and (5) Monitoring (of both mother and neonate as appropriate). The bundle was given the acronym ‘FAST‐M’. Conclusion A clinically relevant maternal sepsis bundle for low resource settings has been developed by international consensus. Tweetable abstract A maternal sepsis bundle for low resource settings has been developed by international consensus. A maternal sepsis bundle for low resource settings has been developed by international consensus.
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Affiliation(s)
- D Lissauer
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi
| | - J Cheshire
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,World Health Organization Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
| | - C Dunlop
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,World Health Organization Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
| | - F Taki
- The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - A Wilson
- World Health Organization Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J M Smith
- The Bill & Melinda Gates Foundation's Maternal, Newborn & Child Health Team, Seattle, WA, USA
| | - R Daniels
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - N Kissoon
- Department of Pediatrics and Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A Malata
- Malawi University of Science and Technology, Limbe, Malawi
| | - T Chirwa
- Chitipa District Hospital, Chitipa, Malawi
| | - V M Lwesha
- Save the Children Norway, Lilongwe, Malawi
| | - C Mhango
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - E Mhango
- Chitipa District Hospital, Chitipa, Malawi
| | - C Makwenda
- Parent and Child Health Initiative (PACHI) Trust, Lilongwe, Malawi
| | - L Banda
- Parent and Child Health Initiative (PACHI) Trust, Lilongwe, Malawi
| | - L Munthali
- Parent and Child Health Initiative (PACHI) Trust, Lilongwe, Malawi
| | - B Nambiar
- Institute for Global Child Health, University College London, London, UK
| | - J Hussein
- Independent Maternal Health Consultant, Aberdeen, UK
| | - H M Williams
- World Health Organization Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK.,Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A J Devall
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,World Health Organization Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
| | - I Gallos
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,World Health Organization Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
| | - A Merriel
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - M Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - J P Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - A Coomarasamy
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,World Health Organization Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
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Affiliation(s)
| | - Scott W. Savage
- University of North Carolina Medical Center, Chapel Hill, N.C
| | - Erinn C. Rowe
- University of North Carolina Medical Center, Chapel Hill, N.C
| | - Rowell Daniels
- University of North Carolina Medical Center, Chapel Hill, N.C
| | - John M. Valgus
- University of North Carolina Medical Center, Chapel Hill, N.C
| | - Richard Redding
- University of North Carolina Medical Center, Chapel Hill, N.C
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Abstract
PURPOSE The considerations that leaders of multihospital health systems must take into account in developing and implementing initiatives to build and maintain an exceptional pharmacy workforce are described. SUMMARY Significant changes that require constant individual and organizational learning are occurring throughout healthcare and within the profession of pharmacy. These considerations include understanding why it is important to have a succession plan and determining what types of education and training are important to support that plan. Other considerations include strategies for leveraging learners, dealing with a large geographic footprint, adjusting training opportunities to accommodate the ever-evolving demands on pharmacy staffs in terms of skill mix, and determining ways to either budget for or internally develop content for staff development. All of these methods are critically important to ensuring an optimized workforce. Especially for large health systems operating multiple sites across large distances, the use of technology-enabled solutions to provide effective delivery of programming to multiple sites is critical. Commonly used tools include live webinars, live "telepresence" programs, prerecorded programming that is available through an on-demand repository, and computer-based training modules. A learning management system is helpful to assign and document completion of educational requirements, especially those related to regulatory requirements (e.g., controlled substances management, sterile and nonsterile compounding, competency assessment). CONCLUSION Creating and sustaining an environment where all pharmacy caregivers feel invested in and connected to ongoing learning is a powerful motivator for performance, engagement, and retention.
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Brands-Appeldoorn ATPM, Maaskant-Braat AJG, Zwaans WAR, Dieleman JP, Schenk KE, Broekhuysen CL, Weerdenburg H, Daniels R, Tjan-Heijnen VCG, Roumen RMH. Patient-reported outcome measurement compared with professional judgment of cosmetic results after breast-conserving therapy. ACTA ACUST UNITED AC 2018; 25:e553-e561. [PMID: 30607123 DOI: 10.3747/co.25.4036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background In the present study, we set out to compare patient-reported outcomes with professional judgment about cosmesis after breast-conserving therapy (bct) and to evaluate which items (position of the nipple, color, scar, size, shape, and firmness) correlate best with subjective outcome. Methods Dutch patients treated with bct between 2008 and 2009 were analyzed. Exclusion criteria were prior amputation or bct of the contralateral breast, metastatic disease, local recurrence, or any prior cosmetic breast surgery. Structured questionnaires and standardized six-view photographs were obtained with a minimum of 3 years' follow-up. Cosmetic outcome was judged by the patients and, based on photographs, by 5 different medical professionals using 3 different scoring systems: the Harvard scale, the Sneeuw questionnaire, and a numeric rating scale. Agreement was scored using the intraclass correlation coefficient (icc). The association between items of the Sneeuw questionnaire and a fair-poor Harvard score was estimated using logistic regression analysis. Results The study included 108 female patients (age: 40-91 years). Based on the Harvard scale, agreement on cosmetic outcome between the professionals was good (icc: 0.78). In contrast, agreement between professionals as a group compared with the patients was found to be fair to moderate (icc range: 0.38-0.50). The items "size" and "shape" were identified as the strongest determinants of cosmetic outcome. Conclusions Cosmetic outcome was scored differently by patients and professionals. Agreement was greater between the professionals than between the patients and the professionals as a group. In general, size and shape were the most prominent items on which cosmetic outcome was judged by patients and professionals alike.
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Affiliation(s)
| | | | - W A R Zwaans
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands
| | - J P Dieleman
- Department of mmc Academy, Máxima Medical Center, Veldhoven, Netherlands
| | - K E Schenk
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands
| | - C L Broekhuysen
- Department of Plastic Surgery, Máxima Medical Center, Veldhoven, Netherlands
| | - H Weerdenburg
- Department of Radiology, Máxima Medical Center, Veldhoven, Netherlands
| | - R Daniels
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands
| | - V C G Tjan-Heijnen
- Division of Medical Oncology, grow-School for Oncology and Developmental Biology, Maastricht, Netherlands
| | - R M H Roumen
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands.,Division of Medical Oncology, grow-School for Oncology and Developmental Biology, Maastricht, Netherlands
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Muluneh B, Schneider M, Faso A, Amerine L, Daniels R, Crisp B, Valgus J, Savage S. Improved Adherence Rates and Clinical Outcomes of an Integrated, Closed-Loop, Pharmacist-Led Oral Chemotherapy Management Program. J Oncol Pract 2018; 14:e324-e334. [DOI: 10.1200/jop.17.00039] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To address the growing use of oral anticancer therapy, an integrated, closed-loop, pharmacist-led oral chemotherapy management program was created within an academic medical center. Methods: An integrated, closed-loop, pharmacy-led oral chemotherapy management program was established. From September 2014 until June 2015, demographic information, rates of adherence, patient understanding of treatment, pharmacist interventions, patient and provider satisfaction, and molecular response rates in patients with chronic myeloid leukemia (CML) were collected. Results: After full implementation, 107 patients were enrolled in our oral chemotherapy management program from September 2014 until June 2015. All patients were educated before starting oral chemotherapy, and using pre- and postassessment tests, comprehension of oral chemotherapy treatment increased from 43% to 95%. Patient-reported adherence was 86% and 94.7% for the GI/breast and malignant hematology patient populations, respectively, and these were validated with medication possession ratio, revealing adherence rates of 85% and 93.9% for the GI/breast and malignant hematology patient populations, respectively. A total of 350 encounters with a clinical pharmacist and 318 adverse effects were reported, which led to 235 interventions. This program led to a higher major molecular response rate (83%) in our CML population compared with published clinical trials (average major molecular response rates, 40% and 60% with 1- and 2-year follow-up, respectively). Conclusion: An innovative model was developed and resulted in improved patient knowledge regarding oral chemotherapy, improved adherence rates that exceeded nationally established thresholds, and superior major molecular response outcomes for patients with CML compared with published literature. As a result, this model has produced the gold standard in managing patients receiving oral chemotherapy.
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Affiliation(s)
- Benyam Muluneh
- University of North Carolina (UNC) at Chapel Hill; UNC Medical Center, Chapel Hill, NC; and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Molly Schneider
- University of North Carolina (UNC) at Chapel Hill; UNC Medical Center, Chapel Hill, NC; and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Aimee Faso
- University of North Carolina (UNC) at Chapel Hill; UNC Medical Center, Chapel Hill, NC; and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Lindsey Amerine
- University of North Carolina (UNC) at Chapel Hill; UNC Medical Center, Chapel Hill, NC; and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Rowell Daniels
- University of North Carolina (UNC) at Chapel Hill; UNC Medical Center, Chapel Hill, NC; and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Brett Crisp
- University of North Carolina (UNC) at Chapel Hill; UNC Medical Center, Chapel Hill, NC; and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - John Valgus
- University of North Carolina (UNC) at Chapel Hill; UNC Medical Center, Chapel Hill, NC; and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Scott Savage
- University of North Carolina (UNC) at Chapel Hill; UNC Medical Center, Chapel Hill, NC; and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
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Amerine LB, Eckel SF, Granko RP, Hatfield C, Savage S, Forshay E, Crisp B, Waldron K, Burgess HC, Daniels R. Improving employee engagement within a department of pharmacy. Am J Health Syst Pharm 2017; 74:1316-1319. [DOI: 10.2146/ajhp160740] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Lindsey B. Amerine
- University of North Carolina Medical Center Chapel Hill, NC
- UNC Eshelman School of Pharmacy Chapel Hill, NC
| | - Stephen F. Eckel
- UNC Eshelman School of Pharmacy Chapel Hill, NC
- University of North Carolina Medical Center Chapel Hill, NC. Dr. Eckel serves on the ASHP Board of Directors. The authors have declared no other potential conflicts of interest
| | - Robert P. Granko
- Moses H. Cone Memorial Hospital Cone Health Greensboro, NC
- UNC Eshelman School of Pharmacy Chapel Hill, NC
| | - Chad Hatfield
- University of North Carolina Medical Center Chapel Hill, NC
- UNC Eshelman School of Pharmacy Chapel Hill, NC
| | - Scott Savage
- University of North Carolina Medical Center Chapel Hill, NC
- UNC Eshelman School of Pharmacy Chapel Hill, NC
| | - Elizabeth Forshay
- UNC Health Care Chapel Hill, NC
- UNC Eshelman School of Pharmacy Chapel Hill, NC
| | - Brett Crisp
- University of North Carolina Medical Center Chapel Hill, NC
- UNC Eshelman School of Pharmacy Chapel Hill, NC
| | - Kayla Waldron
- University of North Carolina Medical Center Chapel Hill, NC
- UNC Eshelman School of Pharmacy Chapel Hill, NC
| | | | - Rowell Daniels
- UNC Health Care Chapel Hill, NC
- UNC Eshelman School of Pharmacy Chapel Hill, NC
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Abstract
Effective medication management is critical to successful patient outcomes. Pharmacists and pharmacy technicians working within North Carolina Health Systems provide a variety of services that aid in those successful outcomes. By leveraging the North Carolina Clinical Pharmacist Practitioner designation along with integrated health records, health system pharmacists are uniquely positioned to provide expert clinical support to patients. Services such as medication history collection, discharge medication dispensing and counseling, post discharge clinic engagement, and drug therapy management are all components of an even larger number of strategic health system pharmacy assets that aid in the care of patients whether they are admitted to hospitals, seen in clinics, or cared for in the community.
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Affiliation(s)
- Paul W Bush
- chief pharmacy officer, Department of Pharmacy, Duke University Hospital, Durham, North Carolina
| | - Rowell Daniels
- system vice president, Pharmacy, UNC Health Care System, Chapel Hill, North Carolina
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Heinrich M, Daniels R, Stintzing FC, Kammerer DR. Comprehensive phytochemical characterization of St. John's wort ( Hypericum perforatum L.) oil macerates obtained by different extraction protocols via analytical tools applicable in routine control. Pharmazie 2017; 72:131-138. [PMID: 29442047 DOI: 10.1691/ph.2017.6749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aim of the present study was to investigate the impact of crucial process parameters, i.e. of light and temperature conditions, during the preparation of St. John's wort (SJW, Hypericum perforatum L.) Arachis oil macerates. Extracts were prepared according to a standardized protocol over a period of 28 days. For this purpose, flowering tops of H. perforatum were macerated with Arachis oil (drug extract ratio, DERnative 1:4) under different light and temperature conditions. Spectrophotometric measurements were carried out to quantitate naphthodianthrones and to characterize extract color in the CIE L*C*h° system. Moreover, individual plant secondary metabolites were screened by UHPLC-DAD-MSn measurements following liquid-liquid extraction of the oil macerates with methanol. For quantitation purposes, the chromatographic method was validated using reference standards. This methodology allowed the separation of up to 25 constituents in oily and methanolic SJW extracts, covering hydroxycinnamic acids, flavanols, proanthocyanidins, flavonol glycosides, flavonol aglyca, biflavones, bisanthraquinone glycosides, naphthodianthrones and phloroglucinols. Lowest naphthodianthrone contents were determined in oil macerates recovered at 5 °C, whereas highest amounts were detected upon extraction at 50 °C (both under the exclusion of light). Color shades of the oil macerates differed markedly, revealing e. g. a*-values ranging from -4.6±0.3 to 42.5±0.3. The flavonoids quercetin, kaempferol and I3, II8-biapigenin as well as the phloroglucinols hyperforin and adhyperforin could be simultaneously detected and quantitated in all oil macerates. Contents of these constituents varied noticeably between macerates prepared under different conditions (quercetin 14.7±1.2 to 21.8±0.6 μg/g, kaempferol 3.0±0.1 to 5.4±0.4 μg/g, I3, II8-biapigenin 4.4±0.2 to 7.4±0.4 μg/g, hyperforin 52.6±46.0 to 451.4±24.9 μg/g, adhyperforin 6.9±5.7 to 74.5±7.1 μg/g). These results confirm that the quality of the resulting plant extracts is largely determined by the respective process parameters, i.e. especially temperature and light conditions, and thus must be thoroughly chosen and monitored to obtain tailor-made preparations.
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Affiliation(s)
- Adam Wolfe
- Cornerstone Health Enablement Strategic Solutions (CHESS), High Point, and UNC Eshelman School of Pharmacy, Chapel Hill, NC
| | - Liz Hess
- St. Vincent Indianapolis Hospital, Indianapolis, IN
| | - Mary K. La
- University of Kentucky HealthCare, Lexington, KY
| | | | - Ryan Moore
- Cornerstone Health Enablement Strategic Solutions (CHESS), High Point, NC
| | - Robert Granko
- Moses H. Cone Memorial Hospital, Greensboro, NC, and UNC Eshelman School of Pharmacy, Chapel Hill, NC
| | - Rowell Daniels
- UNC Medical Center, Chapel Hill, NC, and UNC Eshelman School of Pharmacy, Chapel Hill, NC
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Bates JS, Buie LW, Amerine LB, Savage SW, Eckel SF, Patel R, Valgus JM, Rao K, Daniels R. Expanding care through a layered learning practice model. Am J Health Syst Pharm 2016; 73:1869-1875. [PMID: 27663562 DOI: 10.2146/ajhp150593] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The outcomes of a patient-centered layered learning practice model (LLPM) in which the clinical specialist acted as the attending pharmacist and managed a pharmacy team to provide direct patient care were evaluated. METHODS Two 30-day evaluations were conducted on the acute care malignant hematology and medical oncology services of the University of North Carolina Medical Center in 2011. The primary objective of this study was to design an LLPM that used a team to expand the pharmacist care services offered. The primary outcome was the frequency of pharmacy team encounters at discharge (medication reconciliation and counseling), termed the discharge capture rate. RESULTS During the study months, 42 and 78 malignant hematology and medical oncology patients were eligible for study inclusion, respectively. The overall discharge capture rate was 51%. Sixty-one patients received discharge medication reconciliation services during patient counseling. Patients included in the malignant hematology group received a mean of 11 prescriptions at discharge, compared with 9.83 in the medical oncology group. Means of 1.26 and 2.1 medication-related problems per patient were identified in the malignant hematology and medical oncology studies, respectively, during discharge medication reconciliation. The overall mean face time spent per patient was 21.3 minutes. CONCLUSION Patients in malignant hematology and medical oncology services were counseled and provided discharge medication reconciliation by a pharmacy student or resident whose activities were managed and reviewed by an attending pharmacist using an LLPM, resulting in an improvement in all clinical outcomes and measures.
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Affiliation(s)
- Jill S Bates
- University of North Carolina Medical Center, Chapel Hill, NC .,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.
| | - Larry W Buie
- University of North Carolina Medical Center, Chapel Hill, NC.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Lindsey B Amerine
- University of North Carolina Medical Center, Chapel Hill, NC.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Scott W Savage
- University of North Carolina Medical Center, Chapel Hill, NC.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Stephen F Eckel
- University of North Carolina Medical Center, Chapel Hill, NC.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Rachana Patel
- University of North Carolina Medical Center, Chapel Hill, NC
| | - John M Valgus
- University of North Carolina Medical Center, Chapel Hill, NC.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Kamakshi Rao
- University of North Carolina Medical Center, Chapel Hill, NC.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Rowell Daniels
- University of North Carolina Medical Center, Chapel Hill, NC.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
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Amerine LB, Chen SL, Daniels R, Key N, Eckel SF, Savage SW. Impact of an innovative blood factor stewardship program on drug expense and patient care. Am J Health Syst Pharm 2016; 72:1579-84. [PMID: 26346214 DOI: 10.2146/ajhp140722] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE An innovative pharmacist-led program to improve prescribing, dosing, and monitoring of clotting factor therapy within a large health system is described. SUMMARY In an initiative to optimize patient outcomes and control costs associated with the use of clotting factor concentrates, the pharmacy department at University of North Carolina Medical Center (UNCMC) led the development of a "factor stewardship program" in collaboration with UNCMC hematologists. Key steps in program development and implementation included (1) selection of one formulary product within each clotting factor class, (2) establishment of guidelines on blood factor prescribing, order review, compounding, and administration, and (3) initial and ongoing education of pharmacy, nursing, and medical staff. As part of the program, a designated pharmacist rounds with hematologists daily, recommending treatment plan modifications and dosage adjustments as appropriate. Now in its fifth year, the stewardship program has enabled consistent pharmacist oversight of all aspects of clotting factor use and enhanced transitions-of-care coordination. Through optimization of product selection, dosing regimens, and infusion frequencies, the number of blood factor doses in fiscal year 2013 was reduced by 45% from the prior year despite a 22% increase in the volume of treated patients; in patients with hemophilia A, re-admissions due to bleeding episodes have declined. During the four-year period ending in July 2014, estimated cost savings attributable to the stewardship program exceeded $4 million annually. CONCLUSION Implementation of the UNCMC stewardship program has led to improved outcomes in patients receiving clotting factor concentrates, with significant institutional cost savings.
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Affiliation(s)
- Lindsey B Amerine
- Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, University of North Carolina (UNC) Medical Center, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill. Sheh-Li Chen, Pharm.D., BCOP, is Clinical Specialist, Hematology/Oncology, UNC Medical Center. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Medical Center, and Executive Associate Dean of Clinical Practice, UNC Eshelman School of Pharmacy. Nigel Key, M.B., Ch.B., FRCP, is Chief, Section of Hematology, Division of Hematology/Oncology, UNC Medical Center, and Professor, UNC School of Medicine, Chapel Hill. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, FCCP, is Associate Director of Pharmacy, UNC Medical Center, and Clinical Associate Professor, UNC Eshelman School of Pharmacy. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy.
| | - Sheh-Li Chen
- Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, University of North Carolina (UNC) Medical Center, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill. Sheh-Li Chen, Pharm.D., BCOP, is Clinical Specialist, Hematology/Oncology, UNC Medical Center. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Medical Center, and Executive Associate Dean of Clinical Practice, UNC Eshelman School of Pharmacy. Nigel Key, M.B., Ch.B., FRCP, is Chief, Section of Hematology, Division of Hematology/Oncology, UNC Medical Center, and Professor, UNC School of Medicine, Chapel Hill. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, FCCP, is Associate Director of Pharmacy, UNC Medical Center, and Clinical Associate Professor, UNC Eshelman School of Pharmacy. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy
| | - Rowell Daniels
- Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, University of North Carolina (UNC) Medical Center, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill. Sheh-Li Chen, Pharm.D., BCOP, is Clinical Specialist, Hematology/Oncology, UNC Medical Center. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Medical Center, and Executive Associate Dean of Clinical Practice, UNC Eshelman School of Pharmacy. Nigel Key, M.B., Ch.B., FRCP, is Chief, Section of Hematology, Division of Hematology/Oncology, UNC Medical Center, and Professor, UNC School of Medicine, Chapel Hill. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, FCCP, is Associate Director of Pharmacy, UNC Medical Center, and Clinical Associate Professor, UNC Eshelman School of Pharmacy. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy
| | - Nigel Key
- Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, University of North Carolina (UNC) Medical Center, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill. Sheh-Li Chen, Pharm.D., BCOP, is Clinical Specialist, Hematology/Oncology, UNC Medical Center. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Medical Center, and Executive Associate Dean of Clinical Practice, UNC Eshelman School of Pharmacy. Nigel Key, M.B., Ch.B., FRCP, is Chief, Section of Hematology, Division of Hematology/Oncology, UNC Medical Center, and Professor, UNC School of Medicine, Chapel Hill. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, FCCP, is Associate Director of Pharmacy, UNC Medical Center, and Clinical Associate Professor, UNC Eshelman School of Pharmacy. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy
| | - Stephen F Eckel
- Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, University of North Carolina (UNC) Medical Center, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill. Sheh-Li Chen, Pharm.D., BCOP, is Clinical Specialist, Hematology/Oncology, UNC Medical Center. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Medical Center, and Executive Associate Dean of Clinical Practice, UNC Eshelman School of Pharmacy. Nigel Key, M.B., Ch.B., FRCP, is Chief, Section of Hematology, Division of Hematology/Oncology, UNC Medical Center, and Professor, UNC School of Medicine, Chapel Hill. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, FCCP, is Associate Director of Pharmacy, UNC Medical Center, and Clinical Associate Professor, UNC Eshelman School of Pharmacy. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy
| | - Scott W Savage
- Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, University of North Carolina (UNC) Medical Center, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill. Sheh-Li Chen, Pharm.D., BCOP, is Clinical Specialist, Hematology/Oncology, UNC Medical Center. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Medical Center, and Executive Associate Dean of Clinical Practice, UNC Eshelman School of Pharmacy. Nigel Key, M.B., Ch.B., FRCP, is Chief, Section of Hematology, Division of Hematology/Oncology, UNC Medical Center, and Professor, UNC School of Medicine, Chapel Hill. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, FCCP, is Associate Director of Pharmacy, UNC Medical Center, and Clinical Associate Professor, UNC Eshelman School of Pharmacy. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy
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Affiliation(s)
- Dave Hicks
- University of Chicago Medicine (Retired), Chicago, IL
| | - Brian Swift
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Rowell Daniels
- University of North Carolina Medical Center, Chapel Hill, NC
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Goddard N, Rebelo-de-Andrade H, Meijer A, McCauley J, Daniels R, Zambon M. Future directions for the European influenza reference laboratory network in influenza surveillance. ACTA ACUST UNITED AC 2015; 20. [PMID: 26250071 DOI: 10.2807/1560-7917.es2015.20.30.21195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
By defining strategic objectives for the network of influenza laboratories that have national influenza centre status or national function within European Union Member States, Iceland and Norway, it is possible to align their priorities in undertaking virological surveillance of influenza. This will help maintain and develop the network to meet and adapt to new challenges over the next 3-5 years and underpin a longer-term strategy over 5-10 years. We analysed the key activities undertaken by influenza reference laboratories in Europe and categorised them into a framework of four key strategic objectives areas: enhancing laboratory capability, ensuring laboratory capacity, providing emergency response and translating laboratory data into information for public health action. We make recommendations on the priority areas for future development.
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Affiliation(s)
- N Goddard
- Public Health England (PHE), London, United Kingdom
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15
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Lamm MH, Eckel S, Daniels R, Amerine LB. Using lean principles to improve outpatient adult infusion clinic chemotherapy preparation turnaround times. Am J Health Syst Pharm 2015; 72:1138-46. [DOI: 10.2146/ajhp140453] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Matthew H. Lamm
- Department of Pharmacy, University of North Carolina (UNC) Hospitals—Hillsborough Campus, Chapel Hill
| | - Stephen Eckel
- UNC Hospitals, and Clinical Associate Professor, Eshelman School of Pharmacy, UNC, Chapel Hill
| | - Rowell Daniels
- UNC Hospitals, and Executive Associate Dean of Clinical Practice, Eshelman School of Pharmacy, UNC
| | - Lindsey B. Amerine
- Department of Pharmacy, UNC Hospitals, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC
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16
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Leff DR, Ho C, Thomas H, Daniels R, Side L, Lambert F, Knight J, Griffiths M, Banwell M, Aitken J, Clayton G, Dua S, Shaw A, Smith S, Ramakrishnan V. A multidisciplinary team approach minimises prophylactic mastectomy rates. Eur J Surg Oncol 2015; 41:1005-12. [PMID: 25986853 DOI: 10.1016/j.ejso.2015.02.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/22/2015] [Accepted: 02/12/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Prophylactic mastectomy (PM) has become increasingly common but is not without complications especially if accompanied by reconstructive surgery. In patients with sporadic unilateral breast cancer, contralateral PM offers no survival advantage. Multidisciplinary team (MDT) communication and interaction may facilitate shared decision-making and curtail PM rates. The aim of this study was investigate the effect of a regional MDT meeting on PM decision-making. METHODS We conducted an observational study involving retrospective review of prospectively recorded MDT meeting records for a 151 patient requests for PM from 2011 to 2014. Final MDT decisions were recorded as PM 'accepted', 'declined' or 'pending'. For MDT sanctioned requests, the factors justifying PM were recorded. Where PM was declined, justification for MDT refusal was sought and recorded. RESULTS Approximately half of all requests for PM have been upheld (53.0%) and 1/3 of requests have been declined (32.5%). Of those declined, low risk of contralateral breast cancer versus relatively high risk of systemic relapse were commonly cited as justification for PM refusal (45.7%). A proportion of patients who initiated PM discussion subsequently changed their minds (19.6%), or failed to attend clinic appointments (6.5%). Some patients were deemed medically unfit for complex reconstructive surgery (13%), or were declined on the basis of an apparent cosmetic drive for surgery (6.5%), concerns regarding depression or anxiety (2.2%) and/or if family history could not be substantiated (6.5%). DISCUSSION MDT meetings facilitate cross-specialty interrogation of requests for PM, minimise unnecessary surgery and restrict PM to those likely to derive maximum benefit.
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Affiliation(s)
- D R Leff
- The Breast Unit, Broomfield Hospital, Chelmsford, Essex, United Kingdom
| | - C Ho
- The Breast Unit, Broomfield Hospital, Chelmsford, Essex, United Kingdom
| | - H Thomas
- The Breast Unit, Broomfield Hospital, Chelmsford, Essex, United Kingdom
| | - R Daniels
- The Breast Unit, Broomfield Hospital, Chelmsford, Essex, United Kingdom
| | - L Side
- Institute for Women's Health, University College Hospitals, London, United Kingdom
| | - F Lambert
- Psychological Therapies Department, Mid Essex Hospitals Services NHS Trust, Essex, United Kingdom
| | - J Knight
- Breast Reconstruction Awareness Group, United Kingdom
| | - M Griffiths
- St Andrew's Centre for Burns and Plastic Surgery, Chelmsford, Essex, United Kingdom
| | - M Banwell
- St Andrew's Centre for Burns and Plastic Surgery, Chelmsford, Essex, United Kingdom
| | - J Aitken
- West Suffolk NHS Foundation Trust, Bury St Edmunds, Suffolk, United Kingdom
| | - G Clayton
- The Breast Unit, Mid Essex Hospitals NHS Trust, Broomfield Hospital, Chelmsford, Essex, United Kingdom
| | - S Dua
- The Breast Unit, Broomfield Hospital, Chelmsford, Essex, United Kingdom
| | - A Shaw
- St Andrew's Centre for Burns and Plastic Surgery, Chelmsford, Essex, United Kingdom
| | - S Smith
- The Breast Unit, Broomfield Hospital, Chelmsford, Essex, United Kingdom
| | - V Ramakrishnan
- St Andrew's Centre for Burns and Plastic Surgery, Chelmsford, Essex, United Kingdom.
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17
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Volkman S, Daniels R, Chang H, Park D, Neafsey D, Schaffner S, Lukens A, Mboup S, Sabeti P, Wirth D, Hartl D. Genotyping malaria parasites to understand malaria transmission. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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18
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Woller TW, Knoer S, Daniels R. Strategic considerations for centralization of services across the pharmacy enterprise. Am J Health Syst Pharm 2015; 72:74-7. [DOI: 10.2146/ajhp140401] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Scott Knoer
- Pharmacy Services, Aurora Health Care, Milwaukee, WI
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19
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Amerine LBP, Granko RP, Savage SW, Daniels R, Eckel SF. Experience of health-system pharmacy administration residents in a longitudinal human resource management program. Am J Health Syst Pharm 2014; 71:2143-8. [PMID: 25465586 DOI: 10.2146/ajhp130704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The experience of health-system pharmacy administration (HSPA) residents in a longitudinal human resource (HR) management program is described. The subsequent benefits to the residents, department, and profession are also discussed. SUMMARY Postgraduate year 2 HSPA residents at an academic medical center desired more responsibility for managing an operational area. To this end, a program was created in which these residents directly manage a small group of pharmacy technicians and report to a clinical manager or assistant director with oversight responsibility. These "resident managers" are responsible, under the direction of the area's clinical manager, for the personnel, schedule, time and attendance, and HR activities of the area. Resident managers have led and sustained operational improvement projects in their areas. In addition to providing learning experiences to residents, the HSPA residency program has also improved the operations of the areas in which these residents work. Benefits to the residents include conducting annual performance evaluations for employees with whom they have a relationship as it is a task every administrator completes. Resident managers at UNC have consistently stated that this longitudinal HR experience is one of the most rewarding and most challenging experiences offered in the two-year HSPA residency. The involvement of HSPA residents in longitudinal management responsibilities furthers residents' leadership success by providing trained managers who are ready to immerse themselves into practice postresidency, having employee engagement and HR skills as well as experiences with leading operational improvements. CONCLUSION A longitudinal HR management experience was successfully incorporated into an HSPA residency combined Master of Science degree program.
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Affiliation(s)
- Lindsey B Poppe Amerine
- Lindsey B. (Poppe) Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, Department of Pharmacy, University of North Carolina (UNC) Hospitals, Chapel Hill, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC, Chapel Hill. Robert P. Granko, Pharm.D., M.B.A., is Associate Director of Pharmacy, UNC Hospitals. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, Chapel Hill, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Hospitals, and Executive Associate Dean of Clinical Practice, Eshelman School of Pharmacy, UNC. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, is Associate Director of Pharmacy, UNC Hospitals, and Clinical Associate Professor, Eshelman School of Pharmacy, UNC
| | - Robert P Granko
- Lindsey B. (Poppe) Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, Department of Pharmacy, University of North Carolina (UNC) Hospitals, Chapel Hill, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC, Chapel Hill. Robert P. Granko, Pharm.D., M.B.A., is Associate Director of Pharmacy, UNC Hospitals. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, Chapel Hill, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Hospitals, and Executive Associate Dean of Clinical Practice, Eshelman School of Pharmacy, UNC. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, is Associate Director of Pharmacy, UNC Hospitals, and Clinical Associate Professor, Eshelman School of Pharmacy, UNC
| | - Scott W Savage
- Lindsey B. (Poppe) Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, Department of Pharmacy, University of North Carolina (UNC) Hospitals, Chapel Hill, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC, Chapel Hill. Robert P. Granko, Pharm.D., M.B.A., is Associate Director of Pharmacy, UNC Hospitals. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, Chapel Hill, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Hospitals, and Executive Associate Dean of Clinical Practice, Eshelman School of Pharmacy, UNC. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, is Associate Director of Pharmacy, UNC Hospitals, and Clinical Associate Professor, Eshelman School of Pharmacy, UNC
| | - Rowell Daniels
- Lindsey B. (Poppe) Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, Department of Pharmacy, University of North Carolina (UNC) Hospitals, Chapel Hill, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC, Chapel Hill. Robert P. Granko, Pharm.D., M.B.A., is Associate Director of Pharmacy, UNC Hospitals. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, Chapel Hill, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Hospitals, and Executive Associate Dean of Clinical Practice, Eshelman School of Pharmacy, UNC. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, is Associate Director of Pharmacy, UNC Hospitals, and Clinical Associate Professor, Eshelman School of Pharmacy, UNC
| | - Stephen F Eckel
- Lindsey B. (Poppe) Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, Department of Pharmacy, University of North Carolina (UNC) Hospitals, Chapel Hill, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC, Chapel Hill. Robert P. Granko, Pharm.D., M.B.A., is Associate Director of Pharmacy, UNC Hospitals. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, Chapel Hill, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Hospitals, and Executive Associate Dean of Clinical Practice, Eshelman School of Pharmacy, UNC. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, is Associate Director of Pharmacy, UNC Hospitals, and Clinical Associate Professor, Eshelman School of Pharmacy, UNC.
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20
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Omar E, Daniels R, Alcock L, Brown P, Clarke F, Tuck S, Pathare S, Paul A, Plant M. THU0446 Pilot of an Ambulatory Care Unit in Rheumatology Department. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Bradley-Stewart A, Miller RS, Maclean A, Aitken C, Whittaker L, Gregory V, Daniels R, Gunson R. Cluster of influenza A cases in vaccinated population of adults in Virology Laboratory in Glasgow in December 2012. Scott Med J 2014; 59:95-102. [PMID: 24659378 DOI: 10.1177/0036933014529057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS The majority of influenza infections during the 2012/2013 influenza season in Scotland have been due to influenza A H3N2. We report an outbreak of influenza A H3N2 in a vaccinated population of adults in the Regional Virology Laboratory in Glasgow. This investigation was carried out to confirm the epidemiological link between cases. METHODS AND RESULTS Staff with clinical symptoms of influenza-like illness were included. Samples were tested by real-time polymerase chain reaction and sequencing. Staff were interviewed to obtain information regarding symptom onset and vaccination status. Eight confirmed cases and six clinically diagnosed cases were reported, which all occurred within 4 days of a lunchtime Christmas quiz. The eight samples subtyped as H3 virus. The haemagglutinin gene in the confirmed cases was sequenced and shown to be identical. Most of the attendees had been immunised against influenza with the same vaccine batch at least 6 weeks earlier. CONCLUSION This outbreak appears to have been an isolated incident, which arose due to a social event that provided the ideal conditions for transmission of a respiratory disease. It may have been compounded by low-vaccine effectiveness this season. Sequence data supported the epidemiological link.
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Affiliation(s)
- A Bradley-Stewart
- Principal Clinical Scientist, West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, UK
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22
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Broberg E, Pereyaslov D, Struelens M, Palm D, Meijer A, Ellis J, Zambon M, McCauley J, Daniels R. Laboratory preparedness in EU/EEA countries for detection of novel avian influenza A(H7N9) virus, May 2013. ACTA ACUST UNITED AC 2014; 19. [PMID: 24507469 DOI: 10.2807/1560-7917.es2014.19.4.20682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Following human infections with novel avian influenza A(H7N9) viruses in China, the European Centre for Disease Prevention and Control, the World Health Organization (WHO) Regional Office for Europe and the European Reference Laboratory Network for Human Influenza (ERLI-Net) rapidly posted relevant information, including real-time RT-PCR protocols. An influenza RNA sequence-based computational assessment of detection capabilities for this virus was conducted in 32 national influenza reference laboratories in 29 countries, mostly WHO National Influenza Centres participating in the WHO Global Influenza Surveillance and Response System (GISRS). Twenty-seven countries considered their generic influenza A virus detection assay to be appropriate for the novel A(H7N9) viruses. Twenty-two countries reported having containment facilities suitable for its isolation and propagation. Laboratories in 27 countries had applied specific H7 real-time RT-PCR assays and 20 countries had N9 assays in place. Positive control virus RNA was provided by the WHO Collaborating Centre in London to 34 laboratories in 22 countries to allow evaluation of their assays. Performance of the generic influenza A virus detection and H7 and N9 subtyping assays was good in 24 laboratories in 19 countries. The survey showed that ERLI-Net laboratories had rapidly developed and verified good capability to detect the novel A(H7N9) influenza viruses.
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Affiliation(s)
- E Broberg
- Surveillance and Response Support, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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23
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Grysko M, Daniels R. Evaluation of the mechanism of gelation of an oleogel based on a triterpene extract from the outer bark of birch. Pharmazie 2013; 68:572-577. [PMID: 23923639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Oleogels are known for their high physical, chemical, and mechanical stability and good in vivo efficacy, which make them appropriate vehicles for dermal drug delivery and skin care for very dry skin. Modern formulation research focusses on well tolerated and sustainable formulation concepts. This paper deals with an innovative oleogel, which is based on a triterpene dry extract from the outer bark of birch (TE). In this formulation TE does not only act as an excipient but provides interesting pharmacological properties at the same time. The oleogel was formulated using solely Simmondsia Chinensis seed oil (jojoba oil) and TE. Fluorescence microscopy and confocal Raman microscopy showed that suspended TE particles arrange in a three-dimensional gel network. Infrared spectroscopy revealed that the formation of hydrogen bonds between TE particles is responsible for the self-assembly of TE in oil. Moreover, the influence of TE concentration and morphology of the TE particles on the viscoelasticity of the resulting oleogels was analyzed. Gel strength increased with TE concentration and was critical to the specific surface area of the TE particles.
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Affiliation(s)
- M Grysko
- Pharmazeutische Technologie und Biopharmazie, Pharmazeutisches Institut, Universität Tübingen, Germany
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24
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Lunter D, Daniels R. In vitro skin permeation and penetration of nonivamide from novel film-forming emulsions. Skin Pharmacol Physiol 2013; 26:139-46. [PMID: 23549242 DOI: 10.1159/000348464] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 01/29/2013] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to develop film-forming emulsions (FFE) facilitating long-term treatment of chronic pruritus with capsaicinoids. To this end, oil-in-water emulsions, which comprise dispersions of sustained-release polymers, were examined. Such emulsions form a film when applied to the skin and encapsulate the oily drug solution in a dry polymeric matrix. Permeation of the antipruritic drug nonivamide (NVA) is controlled by the matrix. Permeation rates of NVA from FFE and its concentration in the skin are equivalent to those achieved with a conventional semisolid formulation, but can be maintained for a longer period of time. FFE may therefore improve the treatment of chronic pruritus with capsaicinoids by enhancing patient compliance by means of a sustained-release regimen.
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Affiliation(s)
- D Lunter
- Department of Pharmaceutical Technology, Eberhard Karls University Tübingen, Tübingen, Germany
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25
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Knoer S, Weber RJ, Witmer DR, Zilz DA, Ashby DM, Rough S, Stevenson JG, Bush PW, Daniels R, Calabrese SV, Chen D. Highlights of the Cleveland Clinic Pharmacy Practice Model Summit. Am J Health Syst Pharm 2013; 70:356-65. [DOI: 10.2146/ajhp120433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Scott Knoer
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH
| | - Robert J. Weber
- Pharmacy Department, Ohio State University Medical Center, Columbus
| | - David R. Witmer
- American Society of Health-System Pharmacists (ASHP), Bethesda, MD; at the time of the summit he was Vice President of Member Relations, ASHP
| | - David A. Zilz
- Iola, WI, and Emeritus Clinical Professor of Pharmacy, School of Pharmacy, University of Wisconsin (UW)—Madison
| | | | - Steve Rough
- Pharmacy Department, UW Hospital and Clinics, Madison
| | - James G. Stevenson
- University of Michigan (UM) Hospitals and Health Centers (at the time of the summit he was Director of Pharmacy), and Professor and Associate Dean, College of Pharmacy, UM, Ann Arbor
| | | | - Rowell Daniels
- University of North Carolina Hospitals and Clinics, Chapel Hill
| | | | - David Chen
- Pharmacy Practice Sections, and Director, Section of Pharmacy Practice Managers, ASHP
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26
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Granko RP, Poppe LB, Savage SW, Daniels R, Smith EA, Leese P. Method to determine allocation of clinical pharmacist resources. Am J Health Syst Pharm 2012; 69:1398-404. [DOI: 10.2146/ajhp110510] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Robert P. Granko
- University of North Carolina (UNC) Hospitals, Chapel Hill, and Clinical Assistant Professor, Eshelman School of Pharmacy, UNC, Chapel Hill
| | - Lindsey B. Poppe
- Department of Pharmacy, UNC Hospitals, and Clinical Assistant Professor, Eshelman School of Pharmacy, UNC
| | - Scott W. Savage
- UNC Hospitals, and Clinical Assistant Professor, Eshelman School of Pharmacy, UNC
| | - Rowell Daniels
- UNC Hospitals, and Executive Associate Dean, Pharmacy Clinical Practice, Eshelman School of Pharmacy, UNC
| | | | - Peter Leese
- Performance Improvement and Patient Safety, UNC Hospitals, Chapel Hill
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Fayolle G, Levick W, Lajiness-O'Neill R, Fastenau P, Briskin S, Bass N, Silva M, Critchfield E, Nakase-Richardson R, Hertza J, Loughan A, Perna R, Northington S, Boyd S, Anderson A, Peery S, Chafetz M, Maris M, Ramezani A, Sylvester C, Goldberg K, Constantinou M, Karekla M, Hall J, Edwards M, Balldin V, Strutt A, Pavlik V, Marquez de la Plata C, Cullum M, lacritz L, Reisch J, Massman P, Royall D, Barber R, Younes S, Wiechmann A, O'Bryant S, Patel K, Suhr J, Patel K, Suhr J, Chari S, Yokoyama J, Bettcher B, Karydas A, Miller B, Kramer J, Zec R, Fritz S, Kohlrus S, Robbs R, Ala T, Gifford K, Cantwell N, Romano R, Jefferson A, Holland A, Newton S, Bunting J, Coe M, Carmona J, Harrison D, Puente A, Terry D, Faraco C, Brown C, Patel A, Watts A, Kent A, Siegel J, Miller S, Ernst W, Chelune G, Holdnack J, Sheehan J, Duff K, Pedraza O, Crawford J, Terry D, Puente A, Brown C, Faraco C, Watts A, Patel A, Kent A, Siegel J, Miller L, Younes S, Hobson Balldin V, Benavides H, Johnson L, Hall J, Tshuma L, O'Bryant S, Dezhkam N, Hayes L, Love C, Stephens B, Webbe F, Allen C, Lemann E, Davis A, Pierson E, Lutz J, Piehl J, Holler K, Kavanaugh B, Tayim F, Llanes S, Mulligan K, Poston K, Riccio C, Beathard J, Cohen M, Stolberg P, Hart J, Jones W, Mayfield J, Allen D, Weller J, Dunham K, Demireva P, McInerney K, Suhr J, Dykstra J, Riddle T, Suhr J, Primus M, Riccio C, Highsmith J, Everhart D, Shadi S, Lehockey K, Sullivan S, Lucas M, Mandava S, Murphy B, Donovick P, Lalwani L, Rosselli M, Coad S, Carrasco R, Sofko C, Scarisbrick D, Golden C, Coad S, Zuckerman S, Golden C, Perna R, Loughan A, Hertza J, Brand J, Rivera Mindt M, Denney R, Schaffer S, Alper K, Devinsky O, Barr W, Langer K, Fraiman J, Scagliola J, Roman E, Martinez A, Cohen M, Dunham K, Riccio C, Martin P, Robbins J, Golden C, Axelrod B, Etherton J, Konopacki K, Moses J, Juliano A, Whiteside D, Rolin S, Widmann G, Franzwa M, Sokal B, Mark V, Doyle K, Morgan E, Weber E, Bondi M, Delano-Wood L, Grant I, Sibson J, Woods S, Andrews P, McGregor S, Golden C, Etherton J, Allen C, Cormier R, Cumley N, Elek M, Green M, Ogbeide S, Kruger A, Pacheco L, Robinson G, Welch H, Etherton J, Allen C, Cormier R, Cumley N, Kruger A, Pacheco L, Glover M, Parriott D, Jones W, Loe S, Hughes L, Natta L, Moses J, Vincent A, Roebuck-Spencer T, Bryan C, Padua M, Denney R, Moses J, Quenicka W, McGoldirck K, Bennett T, Soper H, Collier S, Connolly M, Hanratty A, Di Pinto M, Magnuson S, Dunham K, Handel E, Davidson K, Livers E, Frantz S, Allen J, Jerard T, Moses J, Pierce S, Sakhai S, Newton S, Warchol A, Holland A, Bunting J, Coe M, Carmona J, Harrison D, Barney S, Thaler N, Sutton G, Strauss G, Allen D, Hunter B, Bennett T, Quenicka W, McGoldrick K, Soper H, Sordahl J, Torrence N, John S, Gavett B, O'Bryant S, Shadi S, Denney R, Nichols C, Riccio C, Cohen M, Dennison A, Wasserman T, Schleicher-Dilks S, Adler M, Golden C, Olivier T, Schleicher-Dilks S, Golden C, LeMonda B, McGinley J, Pritchett A, Chang L, Cloak C, Cunningham E, Lohaugen G, Skranes J, Ernst T, Parke E, Thaler N, Etcoff L, Allen D, Andrews P, McGregor S, Golden C, Northington S, Daniels R, Loughan A, Perna R, Hertza J, Hochsztein N, Miles-Mason E, Granader Y, Vasserman M, MacAllister W, Casto B, Peery S, Patrick K, Hurewitz F, Chute D, Booth A, Koch C, Roid G, Balkema N, Kiefel J, Bell L, Maerlender A, Belkin T, Katzenstein J, Semerjian C, Culotta V, Band E, Yosick R, Burns T, Arenivas A, Bearden D, Olson K, Jacobson K, Ubogy S, Sterling C, Taub E, Griffin A, Rickards T, Uswatte G, Davis D, Sweeney K, Llorente A, Boettcher A, Hill B, Ploetz D, Kline J, Rohling M, O'Jile J, Holler K, Petrauskas V, Long J, Casey J, Long J, Petrauskas V, Duda T, Hodsman S, Casey J, Stricker S, Martner S, Hansen R, Ferraro F, Tangen R, Hanratty A, Tanabe M, O'Callaghan E, Houskamp B, McDonald L, Pick L, Guardino D, Pick L, Pietz T, Kayser K, Gray R, Letteri A, Crisologo A, Witkin G, Sanders J, Mrazik M, Harley A, Phoong M, Melville T, La D, Gomez R, Berthelson L, Robbins J, Lane E, Golden C, Rahman P, Konopka L, Fasfous A, Zink D, Peralta-Ramirez N, Perez-Garcia M, Puente A, Su S, Lin G, Kiely T, Gomez R, Schatzberg A, Keller J, Dykstra J, Suhr J, Feigon M, Renteria L, Fong M, Piper L, Lee E, Vordenberg J, Contardo C, Magnuson S, Doninger N, Luton L, Balkema N, Drane D, Phelan A, Stricker W, Poreh A, Wolkenberg F, Spira J, Lin G, Su S, Kiely T, Gomez R, Schatzberg A, Keller J, DeRight J, Jorgensen R, Fitzpatrick L, Crowe S, Woods S, Doyle K, Weber E, Cameron M, Cattie J, Cushman C, Grant I, Blackstone K, Woods S, Weber E, Grant I, Moore D, Roberg B, Somogie M, Thelen J, Lovelace C, Bruce J, Gerstenecker A, Mast B, Litvan I, Hargrave D, Schroeder R, Buddin W, Baade L, Heinrichs R, Thelen J, Roberg B, Somogie M, Lovelace C, Bruce J, Boseck J, Berry K, Koehn E, Davis A, Meyer B, Gelder B, Sussman Z, Espe-Pfeifer P, Musso M, Barker A, Jones G, Gouvier W, Weber E, Woods S, Grant I, Johnson V, Zaytsev L, Freier-Randall M, Sutton G, Thaler N, Ringdahl E, Allen D, Olsen J, Byrd D, Rivera-Mindt M, Fellows R, Morgello S, Wheaton V, Jaehnert S, Ellis C, Olavarria H, Loftis J, Huckans M, Pimental P, Frawley J, Welch M, Jennette K, Rinehardt E, Schoenberg M, Strober L, Genova H, Wylie G, DeLuca J, Chiaravalloti N, Hertza J, Loughan A, Perna R, Northington S, Boyd S, Hertza J, Loughan A, Perna R, Northington S, Boyd S, Ibrahim E, Seiam A, Ibrahim E, Bohlega S, Rinehardt E, Lloyd H, Goldberg M, Marceaux J, Fallows R, McCoy K, Yehyawi N, Luther E, Hilsabeck R, Fulton R, Stevens P, Erickson S, Dodzik P, Williams R, Dsurney J, Najafizadeh L, McGovern J, Chowdhry F, Acevedo A, Bakhtiar A, Karamzadeh N, Amyot F, Gandjbakhche A, Haddad M, Taub E, Johnson M, Wade J, Harper L, Rickards T, Sterling C, Barghi A, Uswatte G, Mark V, Balkema N, Christopher G, Marcus D, Spady M, Bloom J, Wiechmann A, Hall J, Loughan A, Perna R, Hertza J, Northington S, Zimmer A, Webbe F, Miller M, Schuster D, Ebner H, Mortimer B, Webbe F, Palmer G, Happe M, Paxson J, Jurek B, Graca J, Meyers J, Lange R, Brickell T, French L, Lange R, Iverson G, Shewchuk J, Madler B, Heran M, Brubacher J, Brickell T, Lange R, Ivins B, French L, Baldassarre M, Paper T, Herrold A, Chin A, Zgaljardic D, Oden K, Lambert M, Dickson S, Miller R, Plenger P, Jacobson K, Olson K, Sutherland E, Glatts C, Schatz P, Walker K, Philip N, McClaughlin S, Mooney S, Seats E, Carnell V, Raintree J, Brown D, Hodges C, Amerson E, Kennedy C, Moore J, Schatz P, Ferris C, Roebuck-Spencer T, Vincent A, Bryan C, Catalano D, Warren A, Monden K, Driver S, Chau P, Seegmiller R, Baker M, Malach S, Mintz J, Villarreal R, Peterson A, Leininger S, Strong C, Donders J, Merritt V, Vargas G, Rabinowitz A, Arnett P, Whipple E, Schultheis M, Robinson K, Iacovone D, Biester R, Alfano D, Nicholls M, Vargas G, Rabinowitz A, Arnett P, Rabinowitz A, Vargas G, Arnett P, Klas P, Jeffay E, Zakzanis K, Vandermeer M, Jeffay E, Zakzanis K, Womble M, Rohling M, Hill B, Corley E, Considine C, Fichtenberg N, Harrison J, Pollock M, Mouanoutoua A, Brimager A, Lebby P, Sullivan K, Edmed S, Silva M, Nakase-Richardson R, Critchfield E, Kieffer K, McCarthy M, Wiegand L, Lindsey H, Hernandez M, Puente A, Noniyeva Y, Lapis Y, Padua M, Poole J, Brooks B, McKay C, Mrazik M, Meeuwisse W, Emery C, Brooks B, Mazur-Mosiewicz A, Sherman E, Brooks B, Mazur-Mosiewicz A, Kirkwood M, Sherman E, Gunner J, Miele A, Silk-Eglit G, Lynch J, McCaffrey R, Stewart J, Tsou J, Scarisbrick D, Chan R, Bure-Reyes A, Cortes L, Gindy S, Golden C, Hunter B, Biddle C, Shah D, Jaberg P, Moss R, Horner M, VanKirk K, Dismuke C, Turner T, Muzzy W, Dunnam M, Miele A, Warner G, Donnelly K, Donnelly J, Kittleson J, Bradshaw C, Alt M, Margolis S, Ostroy E, Rolin S, Higgins K, Denney R, Rolin S, Eng K, Biddle C, Akeson S, Wall J, Davis J, Hansel J, Hill B, Rohling M, Wang B, Womble M, Gervais R, Greiffenstein M, Denning J, Denning J, Schroeder R, Buddin W, Hargrave D, VonDran E, Campbell E, Brockman C, Heinrichs R, Baade L, Buddin W, Hargrave D, Schroeder R, Teichner G, Waid R, Buddin W, Schroeder R, Teichner G, Waid R, Buican B, Armistead-Jehle P, Bailie J, Dilay A, Cottingham M, Boyd C, Asmussen S, Neff J, Schalk S, Jensen L, DenBoer J, Hall S, DenBoer J, Schalk S, Jensen L, Hall S, Miele A, Lynch J, McCaffrey R, Holcomb E, Axelrod B, Demakis G, Rimland C, Ward J, Ross M, Bailey M, Stubblefield A, Smigielski J, Geske J, Karpyak V, Reese C, Larrabee G, Suhr J, Silk-Eglit G, Gunner J, Miele A, Lynch J, McCaffrey R, Allen L, Celinski M, Gilman J, Davis J, Wall J, LaDuke C, DeMatteo D, Heilbrun K, Swirsky-Sacchetti T, Lindsey H, Puente A, Dedman A, Withers K, Chafetz M, Deneen T, Denney R, Fisher J, Spray B, Savage R, Wiener H, Tyer J, Ningaonkar V, Devlin B, Go R, Sharma V, Tsou J, Golden C, Fontanetta R, Calderon C, Coad S, Golden C, Calderon C, Fontaneta R, Coad S, Golden C, Ringdahl E, Thaler N, Sutton G, Vertinski M, Allen D, Verbiest R, Thaler N, Snyder J, Kinney J, Allen D, Rach A, Young J, Crouse E, Schretlen D, Weaver J, Buchholz A, Gordon B, Macciocchi S, Seel R, Godsall R, Brotsky J, DiRocco A, Houghton-Faryna E, Bolinger E, Hollenbeck C, Hart J, Thaler N, Vertinski M, Ringdahl E, Allen D, Lee B, Strauss G, Adams J, Martins D, Catalano L, Waltz J, Gold J, Haas G, Brown L, Luther J, Goldstein G, Kiely T, Kelley E, Lin G, Su S, Raba C, Gomez R, Trettin L, Solvason H, Schatzberg A, Keller J, Vertinski M, Thaler N, Allen D, Gold J, Buchanan R, Strauss G, Baldock D, Ringdahl E, Sutton G, Thaler N, Allen D, Fallows R, Marceaux J, McCoy K, Yehyawi N, Luther E, Hilsabeck R, Etherton J, Phelps T, Richmond S, Tapscott B, Thomlinson S, Cordeiro L, Wilkening G, Parikh M, Graham L, Grosch M, Hynan L, Weiner M, Cullum C, Hobson Balldin V, Menon C, Younes S, Hall J, Strutt A, Pavlik V, Marquez de la Plata C, Cullum M, Lacritz L, Reisch J, Massman P, Royall D, Barber R, O'Bryant S, Castro-Couch M, Irani F, Houshyarnejad A, Norman M, Peery S, Fonseca F, Bure-Reyes A, Browne B, Alvarez J, Jiminez Y, Baez V, Cortes L, Golden C, Fonseca F, Bure-Reyes A, Coad S, Alvarez J, Browne B, Baez V, Golden C, Resendiz C, Scott B, Farias G, York M, Lozano V, Mahoney M, Strutt A, Hernandez Mejia M, Puente A, Bure-Reyes A, Fonseca F, Baez V, Alvarez J, Browne B, Coad S, Jiminez Y, Cortes L, Golden C, Bure-Reyes A, Pacheco E, Homs A, Acevedo A, Ownby R, Nici J, Hom J, Lutz J, Dean R, Finch H, Pierce S, Moses J, Mann S, Feinberg J, Choi A, Kaminetskaya M, Pierce C, Zacharewicz M, Axelrod B, Gavett B, Horwitz J, Edwards M, O'Bryant S, Ory J, Gouvier W, Carbuccia K, Ory J, Carbuccia K, Gouvier W, Morra L, Garcon S, Lucas M, Donovick P, Whearty K, Campbell K, Camlic S, Donovick P, Edwards M, Balldin V, Hall J, Strutt A, Pavlik V, Marquez de la Plata C, Cullum C, Lacritz L, Reisch J, Massman P, Barber R, Royall D, Younes S, O'Bryant S, Brinckman D, Schultheis M, Ehrhart L, Weisser V, Medaglia J, Merzagora A, Reckess G, Ho T, Testa S, Gordon B, Schretlen D, Woolery H, Farcello C, Klimas N, Thaler N, Allen D, Meyer J, Vargas G, Rabinowitz A, Barwick F, Arnett P, Womble M, Rohling M, Hill B, Corley E, Drayer K, Rohling M, Ploetz D, Womble M, Hill B, Baldock D, Ringdahl E, Sutton G, Thaler N, Allen D, Galusha J, Schmitt A, Livingston R, Stewart R, Quarles L, Pagitt M, Barke C, Baker A, Baker N, Cook N, Ahern D, Correia S, Resnik L, Barnabe K, Gnepp D, Benjamin M, Zlatar Z, Garcia A, Harnish S, Crosson B, Rickards T, Mark V, Taub E, Sterling C, Vaughan L, Uswatte G, Fedio A, Sexton J, Cummings S, Logemann A, Lassiter N, Fedio P, Gremillion A, Nemeth D, Whittington T, Hansen R, Reckow J, Ferraro F, Lewandowski C, Cole J, Lewandowski A, Spector J, Ford-Johnson L, Lengenfelder J, Genova H, Sumowski J, DeLuca J, Chiaravalloti N, Loughan A, Perna R, Hertza J, Morse C, McKeever J, Zhao L, Leist T, Schultheis M, Marcinak J, Piecora K, Al-Khalil K, Webbe F, Mulligan K, Robbins J, Berthelson L, Martin P, Golden C, Piecora K, Marcinak J, Al-Khalil K, Webbe F, Mulligan K, Stewart J, Acevedo A, Ownby R, Thompson L, Kowalczyk W, Golub S, Davis A, Lemann E, Piehl J, Rita N, Moss L, Davis A, Boseck J, Berry K, Koehn E, Meyer B, Gelder B, Davis A, Nogin R, Moss L, Drapeau C, Malm S, Davis A, Lemann E, Koehn E, Drapeau C, Malm S, Boseck J, Armstrong L, Glidewell R, Orr W, Mears G. Grand Rounds. Arch Clin Neuropsychol 2012. [DOI: 10.1093/arclin/acs070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Affiliation(s)
- Robert P. Granko
- University of North Carolina (UNC) Hospitals 101 Manning Drive Chapel Hill, NC 27514 Clinical Assistant Professor Eshelman School of Pharmacy UNC at Chapel Hill Chapel Hill, NC
| | | | - Rowell Daniels
- Pharmacy Clinical Practice Eshelman School of Pharmacy UNC at Chapel Hill
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Ritz R, Daniels R, Noell S, Feigl GC, Schmidt V, Bornemann A, Ramina K, Mayer D, Dietz K, Strauss WSL, Tatagiba M. Hypericin for visualization of high grade gliomas: first clinical experience. Eur J Surg Oncol 2012; 38:352-60. [PMID: 22284346 DOI: 10.1016/j.ejso.2011.12.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Revised: 09/19/2011] [Accepted: 12/19/2011] [Indexed: 11/30/2022] Open
Abstract
AIMS We aimed to demonstrate that Hypericin, a component of St. Johns Wort, selectively visualizes malignant gliomas. Hypericin is known as one of the most powerful photosensitizers in nature with excellent fluorescent properties. METHODS In five patients with a recurrence of a malignant glioma a newly developed water soluble formulation of hypericin was given intravenously (0.1 mg/kg body weight) 6 h before the surgical procedure. Tumor resection was performed under white light and fluorescence mode. The intensity grade of the tissue fluorescence was categorisized by the surgeon in three grades, highly fluorescent, weakly fluorescent and not fluorescent. In these areas tissue samples were taken and investigated by two blinded independent neuropathologists. Tissue samples were histologically classified differentiating between tumor tissue, tumor necrosis, tissue with scattered tumor cells and normal brain tissue. RESULTS In all patients tumor tissue was clearly distinguishable by its typically red fluorescence color from normal brain tissue which was colored blue under a special fluorescent filter. Histological evaluation of the 110 tissue samples showed a specificity of 100% and sensitivity of 91% for one of the two neuropathologists, whereas specificity for second pathologist was 90% and sensitivity 94%. The i.v. application of Hypericin proofed to be safe in all cases and there were no side effects observed. CONCLUSION Hypericin in its water soluble form is a well tolerated drug. In addition to its high photosensitizing properties hypericin will open up interesting new therapeutic possibilities especially when used in combination with fluorescence detection and simultaneously photodynamic therapy.
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Affiliation(s)
- R Ritz
- Klinik für Neurochirurgie, Eberhard Karls Universität Tübingen, Germany.
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Metzelthin SF, Daniels R, van Rossum E, de Witte LP, van den Heuvele WJA, Kempen GIJM. [The psychometric properties of three self-report screening instruments for identifying frail older people in the community]. Tijdschr Gerontol Geriatr 2011; 42:120-30. [PMID: 21834306 DOI: 10.1007/s12439-011-0022-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Frailty can lead towards serious adverse consequences, such as disability. With regard to prevention valid screening instruments are needed to identify frail older people. The aim was to evaluate and compare the psychometric properties of three screening instruments: the Groningen Frailty Indicator (GFI), the Tilburg Frailty Indicator (TFI) and the Sherbrooke Postal Questionnaire (SPQ). For validation purposes the Groningen Activity Restriction Scale (GARS) was added. METHODS A questionnaire was sent to 687 older people (> or = 70 years). (1) Agreement between instruments, (2) internal consistency, (3) cumulative scalability according to Mokken scale analysis and (4) construct validity were evaluated. RESULTS The response rate was 77%. Prevalence estimates of frailty ranged from 40% to 59%. The highest agreement was found between the GFI and TFI (Cohen's kappa = 0.74). Cronbach's alpha for the GFI, TFI and SPQ was 0.73, 0.79 and 0.26, respectively. The scalability of the three instruments was inadequate (Loevinger's H: 0.28, 0.30 and 0.09 for GFI, TFI and SPQ, respectively). Frailty scores correlated significantly with each other and with the GARS scores. CONCLUSION Especially the GFI and TFI seem to be useful to identify frail older people. Further research regarding their predictive validity is still needed.
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Affiliation(s)
- S F Metzelthin
- Vakgroep Verpleging en Verzorging, CAPHRI School for Public Health and Primary Care, Universiteit Maastricht
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Nutbeam T, Daniels R. Early goal-directed therapy: can the emergency department deliver. Arch Emerg Med 2011; 28:250. [DOI: 10.1136/emj.2010.100347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Daniels R. Drug Formulation, I. Rascz, 416 S., 106 Abb., 48 Tab., 68 Schemata, John Wiley & Sons, New York-Brisbane-Toronto-Singapore, 1989; 61 Pfund Sterling. Arch Pharm (Weinheim) 2011. [DOI: 10.1002/ardp.2503241124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Daniels R, Nutbeam T, McNamara G, Galvin C. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emerg Med J 2010; 28:507-12. [DOI: 10.1136/emj.2010.095067] [Citation(s) in RCA: 191] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jenkins A, Rowe E, Granko R, Pfeiffenberger T, Daniels R. Effects of a new sterile product preparation and delivery process on operational efficiency and cost. Am J Health Syst Pharm 2010; 67:1645-9. [DOI: 10.2146/ajhp090470] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Alexander Jenkins
- Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill
| | - Erinn Rowe
- Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill
| | - Robert Granko
- Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill
| | - Trista Pfeiffenberger
- Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill
| | - Rowell Daniels
- Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill
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Benlahrech A, Harris J, Meiser A, Papagatsias T, Hornig J, Hayes P, Lieber A, Athanasopoulos T, Bachy V, Daniels R, Fisher K, Gotch F, Klavinskis L, Seymour L, Logan K, Barbagallo R, Dickson G, Patterson S. OA07-02. Adenovirus vectors induce expansion of memory CD4 T cells with a mucosal homing phenotype that are readily susceptible to HIV-1 infection. Retrovirology 2009. [PMCID: PMC2767574 DOI: 10.1186/1742-4690-6-s3-o50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Papagatsias T, Athanasopoulos T, Meiser A, Benlahrech A, Li F, Self S, Harris J, Roesen N, Bachy V, Klavinskis L, Fisher K, Oh S, Kwong S, Daniels R, Seymour L, Dickson G, Patterson S. P17-21. Using ubiquitin fusion to augment CD8+ T cell immune responses against HIV-1 antigens. Retrovirology 2009. [PMCID: PMC2767808 DOI: 10.1186/1742-4690-6-s3-p303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Goddard N, Zucs P, Ciancio B, Plata F, Hungnes O, Mazick A, Meijer A, Hay A, Daniels R, Nicoll A, Zambon M. Start of the influenza season 2008-9 in Europe - increasing influenza activity moving from West to East dominated by A(H3N2). Euro Surveill 2009. [DOI: 10.2807/ese.14.03.19097-en] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The influenza season 2008-9 started in week 49 of 2008 and is so far characterised by influenza virus type A subtype H3N2. Isolates of this subtype that were tested proved susceptible to neuraminidase inhibitors, but resistant to M2 inhibitors. The circulating A(H3N2) viruses are antigenically similar to the component in the current northern hemisphere influenza vaccine.
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Affiliation(s)
- N Goddard
- Health Protection Agency, London, United Kingdom
| | - P Zucs
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - B Ciancio
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - F Plata
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - O Hungnes
- Norwegian Institute of Public Health, Oslo, Norway
| | - A Mazick
- Statens Serum Institut, Copenhagen, Denmark
| | - A Meijer
- Community Network of Reference Laboratories (CNRL) for Human Influenza in Europe,
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - A Hay
- MRC National Institute for Medical Research, London, United Kingdom
- Community Network of Reference Laboratories (CNRL) for Human Influenza in Europe,
| | - R Daniels
- MRC National Institute for Medical Research, London, United Kingdom
- Community Network of Reference Laboratories (CNRL) for Human Influenza in Europe,
| | - A Nicoll
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - M Zambon
- Health Protection Agency, London, United Kingdom
- Community Network of Reference Laboratories (CNRL) for Human Influenza in Europe,
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Goddard N, Zucs P, Ciancio B, Plata F, Hungnes O, Mazick A, Meijer A, Hay A, Daniels R, Nicoll A, Zambon M. Start of the influenza season 2008-9 in Europe - increasing influenza activity moving from West to East dominated by A(H3N2). Euro Surveill 2009; 14:19097. [PMID: 19161722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
The influenza season 2008-9 started in week 49 of 2008 and is so far characterised by influenza virus type A subtype H3N2. Isolates of this subtype that were tested proved susceptible to neuraminidase inhibitors, but resistant to M2 inhibitors. The circulating A(H3N2) viruses are antigenically similar to the component in the current northern hemisphere influenza vaccine.
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Affiliation(s)
- N Goddard
- Health Protection Agency, London, United Kingdom.
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Mukerji S, Daniels R, Maung K, Mattin A. Central venous catheter-related infection: a cohort study evaluating dedicated central venous catheter packs. Crit Care 2009. [PMCID: PMC2776195 DOI: 10.1186/cc8078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Weiß G, Knoch A, Laicher A, Stanislaus F, Daniels R. Microencapsulation of Ibuprofen by A Coacervation Process Using Eudragit L100–55 as An Enteric Polymer. Drug Dev Ind Pharm 2008. [DOI: 10.3109/03639049309050176] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Janssens JCA, Steenackers H, Metzger K, Daniels R, Ptacek D, Verhoeven T, Hermans K, Vanderleyden J, De Vos DE, De Keersmaecker SCJ. Interference with the quorum sensing systems of Salmonella enterica serovar typhimurium: possibilities and implications. Commun Agric Appl Biol Sci 2007; 72:35-39. [PMID: 18018856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- J C A Janssens
- Centre of Microbial and Plant Genetics, K.U. Leuven, Belgium
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Debatisse D, Pralong E, Daniels R, Roulet R, Villemure J. P02.11 Bilateral on-line EEG and EcoG during peri-insular hemispherotomy: Methodology and demonstration of dependent secondary epileptogenesis (mirror focus). Clin Neurophysiol 2006. [DOI: 10.1016/j.clinph.2006.06.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Re-analysis of the influenza pandemic of 1918 has given reassurance about a rather low reproductive number (R(o)), a prolonged herald wave of virus and that the skewed mortality towards the young adult could be a singularly unique event dependent upon previous infection history, perhaps not to be repeated in a future pandemic. Over 99% of those who contracted the virus survived, in spite of the absence of antivirals, vaccine and antibiotics for the secondary bacteria infections which probably accounted for one-third of the 50 million deaths. Therefore, in spite of a three-fold population increase since 1918 and 100 thousand plane journeys daily, judicious and careful planning together with a stockpile of antiviral drugs, oseltamivir, zanamivir and M2 blockers and a generic H5N1 vaccine, and application of hygiene would be expected to reduce mortality in a new pandemic, to figures significantly less than 1918.
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Affiliation(s)
- J S Oxford
- Retroscreen Virology Ltd., Centre for Infectious Diseases, Bart's and the London, Queen Mary's School of Medicine and Dentistry, 327 Mile End Road, London E1 4NS, United Kingdom.
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Spencer DC, Leininger A, Daniels R, Granko RP, Coeytaux RR. Effect of a computerized prescriber-order-entry system on reported medication errors. Am J Health Syst Pharm 2005; 62:416-9. [PMID: 15745896 DOI: 10.1093/ajhp/62.4.0416] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Donald C Spencer
- Department of Family Medicine, UNC Hospitals, Chapel Hill, NC, USA
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