The Perceived Influence of Clinical Pharmacy Services on Physician Prescribing Behavior: A Matched-Pair Comparison of Pharmacists and Physicians

In contrast with cross-sectional designs used in previous studies, this exploratory study compared survey data from 127 matched pairs of clinical pharmacists and physicians working together. Physicians' perceptions of the importance of clinical pharmacy activities for patient care and the competence of pharmacists performing the activities were examined for their influence on prescribing behavior in an institutional setting. Data from a national survey showed that physicians rated pharmacists higher regarding recommendations based on drug use evaluations (p = 0.004) and competency to provide all clinical pharmacy services. Scores for pharmacokinetics ratings were similar between pharmacists and physicians (p = 0.168). Pharmacists rated the importance of recommendations based on cost-effectiveness higher than physicians (p = 0.012). Overall, physicians' perceptions of activity importance for patient care and pharmacist competency appear to dictate pharmacists' influence on physician prescribing behavior (R = 0.723).     

Pharmaceutical Marketing: Implications for Medical Residency Training

An educational intervention was developed to improve family practice residents' ability to obtain useful information from pharmaceutical representatives. The curriculum is based on the traditional one-on-one drug detail. The objectives are to develop residents' skills in controlling the interview, promote skills for critically analyzing drug-promotional material, and discuss ethical issues. The contents include an assessment tool, suggested readings, and interview questions with rationale. After 5 years, residents' confidence in all areas of the curriculum improved significantly.     

Gasless laparoscopic esophagomyotomy

A case of gasless laparoscopic esophagogastric myotomy for achalasia is presented. The technical aspects of the technique as well as the benefits of this approach are reviewed.     

A multi-perspective survey of mental health consumer needs

Conclusions There is extensive evidence that perspectives on mental health consumer needs vary widely between consumers and other stakeholders-administrators, practitioners, and family members. Traditional methods of determining mental health consumer needs, based on professional input only, have inhibited program development. While progress has been achieved when shared goals have been identified, it has also been inhibited by a lack of known areas of consensus between stakeholder groups.Surveys provide a cost-effective step toward documenting shared views from stakeholders who have the greatest stake in influencing the size and direction of the mental health service system. Identifying shared views is necessary to coordinate stakeholder efforts. The most encouraging result of the surveys is that there are many areas of consensus and thus the potential exists for the stakeholders to coordinate their efforts toward shared goals to better meet important consumer needs by prioritizing services, improving practitioner training, and coordinating advocacy.     

Two Novel Pyrrolopyrimidine Lipid Peroxidation Inhibitors U-101033E and U-104067F Protect Facial Motor Neurons Following Neonatal Axotomy

Recent reports suggest that oxygen radical-induced lipid peroxidation plays a role in the retrograde degeneration of motor neurons following facial nerve axotomy in the neonatal rat. The purpose of the present study was to explore this notion further by testing the neuroprotective properties of two novel brain-penetrating, lipid peroxidation inhibitors, U-101033E and U-104067F, in this model of neuronal degeneration. In Experiment 1, 14-day-old rats were pretreated with 3, 10, or 30 mg/kg U-101033E (po) 10 min before right facial nerve axotomy (Day 0) and then posttreated once a day from Day 1 to Day 6, and once every other day from Day 8 to Day 21. Rats were sacrificed 21 days postaxotomy and surviving cholinergic cell bodies were identified using choline acetyltransferase immunocytochemistry. Both 10 and 30 mg/kg U-101033E significantly enhanced motor neuron survival, with survival rates of 65.9–88.9% being noted in comparison to 51.7–62% survival in vehicle controls (P ≤ 0.05). Experiment 2 demonstrated a significant neuroprotective effect of 10 and 30 mg/kg U-104067F using the same dosing schedule. Experiment 3 was designed to test whether shorter periods of drug exposure (e.g., 5 or 7 days) would be sufficient to preserve motor neurons in rats treated with 10 mg/kg U-101033E. The results suggested that as little as 5 days of drug treatment is sufficient to enhance motor neuron survival. Finally, Experiment 4 demonstrated an 18–19% increase in motor neuron survival in rats treated with 10 and 30 mg/kg U-104067F for 5 consecutive days postaxotomy. Taken together, the attenuation of motor neuron degeneration by the two pyrrolopyrimidine lipid peroxidation inhibitors, U-101033E and U-104067F, lends support to the notion that lipid peroxidation contributes to the pathogenesis of axotomy-induced neurodegeneration.     

Fungal endocarditis — a report on seven cases and a brief review

Summary Candida endocarditis is an unusual but severe complication of systemic infection caused byCandida albicans and occasionally by other fungal species. We describe seven cases that occurred during a period of 20 years in western Sweden. In four cases infections were located on prosthetic valves and in three cases native valves were involved. Three patients died of the disease in the acute phase. A definite diagnosis was established in one of four survivors. This patient had an aortic valve endocarditis and a saddle embolisation and was treated with immediate surgery, followed by intensive treatment with liposomal amphotericin B + flucytosine. Fungal endocarditis is still a serious disease with a high mortality and whenever the diagnosis is suspected, antifungal therapy must be started and transesophageal sonography should be performed to visualize vegetations. Immediate surgery should be considered.

---

Pilzendokarditis — Bericht über sieben Fälle und kurze Literaturübersicht

Zusammenfassung DieCandida-Endokarditis ist eine seltene, aber schwere Komplikation einer systemischen Infektion durchCandida albicans und gelegentlich auch durch andere Pilzspezies. Wir berichten über sieben Fälle, die in einem Zeitraum von 20 Jahren in Westschweden beobachtet wurden. In vier Fällen waren Klappenprothesen und in drei Fällen natürliche Klappen betroffen. Drei Patienten starben in der akuten Phase an der Krankheit. Bei einem der vier überlebenden Patienten konnte die Diagnose eindeutig gesichert werden. Dieser Patient hatte eine Aortenklappenendokarditis und einen reitenden Embolus. Er wurde sofort operiert und hochdosiert mit liposomalem Amphotericin B und mit Flucytosin behandelt. Die Pilzendokarditis ist nach wie vor eine ernste, mit hoher Letalität belastete Krankheit. Die antimykotische Therapie muß bereits beim ersten Verdacht begonnen werden. Um Vegetationen nachzuweisen, sollte die transösophageale Sonographie durchgeführt werden. Ein sofortiges chirurgisches Eingreifen ist zu erwägen.

     

Up-Regulation by Cyclosporine (CsA) of the In Vitro Release of Soluble CD23 (sCD23) and of the In Vitro Production of IL-6 and IgM

In the present study, we examined the effect of CsA on the in vitro production of Ig and on the in vitro production of molecules known to have B-cell growth and differentiation activities, such as IL-6 and sCD23. For the purpose of this study, we developed an experimental In vitro system closely resembling an In vivo model of ongoing B-cell activation. Pre-activated B cells proliferated and produced IgM optimally when they were re-cultured in the presence of IL-2/IL-6. CsA down-regulated the IL-2/IL-6-induced proliferative responses of pre activated B cells by at least 50%., but it up-regulated IgM production in the same experiments. This up regulating effect was not cytokine-related since it was also seen when cells were re-cultured in the absence of any cytokines. Optimal release of sCD23 was observed when SAC-pre-activated B cells were re cultured in the presence of IL-4 or IL-4 plus IL-2 and CsA up-regulated significantly the release of this molecule in these cultures. Finally, CsA was shown to inhibit PHA-induced cell proliferation of PBMC and to up-rcgulate IL-6 production in the same cultures. We conclude that CsA can amplify in vitro both the production of Ig and the release of sCD23 by pre activated B cells. This finding, in combination with the CsA-induced up-regulation of lectin-induced IL-6 production, may have clinical implications in disease states with an ongoing immune activation, where prolonged administration of CsA might be anticipated.