Clinical significance of hemoglobin decrease in emergency department elderly hip fracture patients

Objective@#Decreases in the hemoglobin level compared to the pre-injury lab results are often observed in patients with elderly hip fractures visiting the emergency department (ED). This decrease could be the outcome of the fracture itself or a complication caused by comorbidities. This study examined whether significant hemoglobin decreases, as detected in the ED, are related to other-than-hip-fracture bleeding focus or clinical outcomes. @*Methods@#The electronic medical records were reviewed retrospectively at a single university ED from January 2012 to March 2019. ED diagnoses of hip fractures were screened and enrolled if the patient was 60 years or older and had hemoglobin levels recorded within the previous 6 months. A significant decrease in the hemoglobin level is defined as more than 2 g/dL. @*Results@#Three hundred patients were enrolled in this study. Significant hemoglobin decreases were apparent in 43 patients (14.3%). Only four patients (1.3%) had an other-than-hip-fracture bleeding focus. One of those had a significant hemoglobin decrease. In a “significant decrease” versus “non-significant decrease” intergroup comparison, length of hospital stays (median and interquartile range: 17.0 [15.0-21.5] vs. 17.0 [12.0-21.0], P=0.55), survival discharge (4.7% vs. 2.3%, P=0.72), and other-than-hip-fracture bleeding focus (2.3% vs. 1.2%, P>0.99) did not differ significantly. @*Conclusion@#A decrease in hemoglobin level is common among elderly hip fracture patients. On the other hand, the incidence of other-than-hip-fracture bleeding focus was rare and unrelated to a decrease in significant hemoglobin levels. Similarly, neither the hospital length of stay nor survival discharge was unrelated to the hemoglobin level decrease.

Continuing Professional Development of Pharmacists and The Roles of Pharmacy Schools

Pharmacists should maintain professional competencies to provide optimal pharmaceutical care services to patients, which can be achieved through continued commitment to lifelong learning. Traditionally continuing education (CE) has been widely used as a way of lifelong learning for many healthcare professionals. It, however, has several limitations. CE is delivered in the form of instructor-led education focused on multiple learners. Learning is passive and reactive for participants, so it sometimes does not lead to bringing behavioral changes in workplace performance. Therefore, recently the concept of lifelong learning tends to move from CE toward continuing professional development (CPD). CPD is an ongoing process that improves knowledge, skills, and competencies throughout a professional’s career. It is a more comprehensive structured approach toward the enhancement of personal competencies. It emphasizes an individual’s learning needs and goals and enables learning to become proactive, conscious, and self-directed. CPD consists of four stages: reflect, plan, learn, and evaluate. CE is one component of CPD. Each stage is recorded in a CPD portfolio. There are many practical difficulties in implementing the complete CPD system for lifelong learning of pharmacists in many countries including Korea. Applying a hybrid form that utilizes CPD and CE together, as in the case of some countries, could be an alternative. Furthermore, in undergraduate pharmacy education, it is necessary to teach students about CPD and train them on how to perform CPD as a pharmacist.

Successful Erythropoietin Therapy after Alemtuzumab and Cyclosporin a Treatment for Epoetin-Induced Pure Red Cell Aplasia / 대한내과학회지

Pure red cell aplasia (PRCA) in adults is usually idiopathic, although some underlying conditions can cause PRCA. Immunosuppressive therapy (IST) is used to treat PRCA, but IST has side effects and may fail. The anti-CD52 monoclonal antibody alemtuzumab (ALM) was recently used to successfully treat therapy-resistant PRCA. We herein report successful treatment of secondary PRCA after erythropoietin therapy using ALM and cyclosporin A (CsA) in one patient. The total dose of ALM was 60 mg over 3 days (10, 20, and 30 mg, respectively) plus CsA for at least 6 months. The patient achieved a complete response 18 months after ALM-CsA treatment and his treatment could be changed to a different erythropoietin-stimulating agent.

First isolation of Salmonella I 4,5,12:i:- from domestic animals in Korea / 대한수의학회지

Salmonella I 4,[5],12:i:- was a monophasic variant of Salmonella (S.) Typhimurium and notorious for re-emerging candidate which would replace S. Typhimurium DT104 for antibiotic resistance. Recently, isolation rate was increased on human and industrial animals but there was no case in domestic animals but human in Korea. This was first isolation case from domestic animals in Korea. The five isolates from feces of duck (n = 3), chicken (n = 1), and wild bird (n = 1) showed antibiotic resistance against cephems and aminoglycosides. These means that the spread of emerging bacterial pathogens to domestic animals and the need of systemic management for Salmonella I 4,[5],12:i:-.

Royal jelly enhances migration of human dermal fibroblasts and alters the levels of cholesterol and sphinganine in an in vitro wound healing model

Oral administration of royal jelly (RJ) promotes wound healing in diabetic mice. Concerns have arisen regarding the efficacy of RJ on the wound healing process of normal skin cells. In this study, a wound was created by scratching normal human dermal fibroblasts, one of the major cells involved in the wound healing process. The area was promptly treated with RJ at varying concentrations of 0.1, 1.0, or 5 mg/ml for up to 48 hrs and migration was analyzed by evaluating closure of the wound margins. Furthermore, altered levels of lipids, which were recently reported to participate in the wound healing process, were analyzed by HPTLC and HPLC. Migration of fibroblasts peaked at 24 hrs after wounding. RJ treatment significantly accelerated the migration of fibroblasts in a dose-dependent manner at 8 hrs. Although RJ also accelerated the migration of fibroblasts at both 20 hrs and 24 hrs after wounding, the efficacy was less potent than at 8 hrs. Among various lipid classes within fibroblasts, the level of cholesterol was significantly decreased at 8 hrs following administration of both 0.1 ug/ml and 5 mg/ml RJ. Despite a dose-dependent increase in sphinganines, the levels of sphingosines, ceramides, and glucosylceramides were not altered with any concentration of RJ. We demonstrated that RJ enhances the migration of fibroblasts and alters the levels of various lipids involved in the wound healing process.