Electronic medical record prompts for lab orders in patients initiating statins.

BACKGROUND: The Institute of Medicine (IOM) reports that at least a fourth of all medication related injuries are preventable. Therefore, the IOM recommends healthcare organizations and providers implement electronic prescribing and clinical decision support systems in practices to aid in medication error prevention. OBJECTIVE: To assess the impact of noninstrusive-intrusive prompts from an electronic medical record on recommended baseline and follow up laboratory monitoring, CK and liver transaminase levels (AST and ALT), in patients initiated on statin therapy. METHODS: Hybrid nonintrusive-intrusive prompts for laboratory monitoring specific for statin initiation were implemented in the electronic medical record system in a community based, university affiliated family medicine residency program. A retrospective chart review was conducted to compare and assess laboratory monitoring in patients initiated on statin therapy from two specific time periods: a six month period prior to initiation of the prompts and a six month period after initiation of the prompts. RESULTS: One hundred seventy three patients met inclusion criteria. There were no significant differences in assessment of baseline liver transaminases and CK levels from the initial study period to the follow up study period. There were significant differences in follow up liver transaminase levels (18% vs 33%, p = 0.035) and CK levels (none vs 7%, p = 0.03) from the initial study period to the activated prompt interval. CONCLUSION: A hybrid nonintrusive-intrusive specific prompts for laboratory monitoring triggered by statin initiation within an electronic medical record improved follow up lab assessments for liver transaminases and CK but did not improve baseline assessments of CK or liver transaminases.

Prediction of Henry's law constants by a quantitative structure property relationship and neural networks.

Multiple linear regression analysis and neural networks were employed to develop predictive models for Henry's law constants (HLCs) for organic compounds of environmental concern in pure water at 25 degrees C, using a set of quantitative structure property relationship (QSPR)-based descriptors to encode various molecular structural features. Two estimation models were developed from a set of 303 compounds using 10 and 12 descriptors, one of these models using two descriptors to account for hydrogen-bonding characteristics explicitly; these were validated subsequently on an external set of 54 compounds. For each model, a linear regression and neural network version was prepared. The standard errors of the linear regression models for the training data set were 0.262 and 0.488 log(H(cc)) units, while those of the neural network analogues were lower at 0.202 and 0.224, respectively; the linear regression models explained 98.3% and 94.3% of the variance in the development data, respectively, the neural network models giving similar quality results of 99% and 98.3%, respectively. The various descriptors used describe connectivity, charge distribution, charged surface area, hydrogen-bonding characteristics, and group influences on HLC values.

Hypokalaemic periodic paralysis in a thyrotoxic Polynesian.

Hypokalaemic periodic paralysis in a thyrotoxic Polynesian is described. The possible pathophysiology is discussed. Though common in Orientals, this condition is uncommon in Caucasians and has not been described before in a Polynesian.

Parathyroid imaging with thallium-201 subtraction scintigraphy: a report of 33 cases.

Thallium-201 subtraction scintigraphy has been used in Wellington Hospital for preoperative localisation of parathyroid adenomas since 1984. The technique wa audited by comparing the scan reports with the outcome at operation in 33 patients, 30 of whom underwent a primary exploration. In our unselected patients we found the technique to have poor sensitivity (45.4%) with a high false positive rate (21%). There was no difference in the mean size of the glands correctly identified compared to those that were missed. Our experience has led us to believe that thallium-201 subtraction scintigraphy has not lived up to its early promise and is not a useful technique for routine preoperative localisation of parathyroid adenomas.

Resolution of acromegaly after removal of a bronchial carcinoid shown to secrete growth hormone releasing factor.

A 29 year old woman with an enlarged pituitary fossa and classical acromegaly, possibly present for ten years, had biochemical and partial somatic resolution of the disorder after removal of a bronchial carcinoid tumour. In addition, galactorrhea stopped, menstruation returned after two years, and amenorrhea and elevated prolactin levels fell towards normal. Immunocytochemistry showed numerous growth hormone releasing factor (GRF) staining cells in the tumour. The tumour cells, when cultured, produced a supernatant selectivity stimulating human pituitary somatotrophic cell cultures to produce growth hormone (GH). The bronchial carcinoid did not secrete detectable GH, but extracts of it, and preoperative serum contained GRF immunoreactivity which coeluted with synthetic human pancreatic GRF.

Guar gum is not a panacea in diabetes management.

Guar gum was incorporated into the diets of six insulin dependent diabetics drawn from one general practice. Amounts between 6 and 59.6 g daily were used for four to six weeks and compared with a previous two week control period. Unlike some other studies, little improvement was obtained in diabetic control and a small reduction in cholesterol levels occurred. The guar was well tolerated in amounts below 30 g a day.