Optimizing the pharmacotherapy of vascular surgery patients by medication reconciliation.

AIM: Medication errors may occur at any stage during the medication process and can lead to preventable adverse drug events and patients' harm. Pharmacists' support for reconcilable medication has been shown to be effective, rectifying errors and inaccuracies of the drug treatment and in the increase of medication safety. However, none of the previous studies focused on vascular patients. We investigated the nature and frequency of drug-related problems (DRPs) including the amount of potentially inappropriate medication (PIM) prescribed for elderly patients suffering from vascular diseases and the influence of pharmacists in the improvement of cardiovascular medication. METHODS: After the patients' routine admission process, medication reconciliation was performed. Therefore, a pharmacist obtained an accurate medication use history. The patients' drug therapy was critically screened for DRPs and referring to this, intervention was made by the pharmacist and communicated to the physician if necessary. Potentially inappropriate medication in the elderly was reviewed through a retrospective analysis using the Priscus-List. DRPs were documented anonymously and classified. RESULTS: We identified 138 DRPs among 105 patients. Sixty-five patients experienced at least 1 DRP, accordingly 1.3 DRPs per patient. In total, 43 unintended discrepancies between current medication and admission medication were detected with an overall rate of 0.41 per patient; 100 interventions were made of which 56 resulted in explicit recommendations for prescription changes. Drug classes frequently affected by DRPs were antihypertensive in 23.9%, antithrombotic agents in 19.3% and lipid lowering agents in 12.1%. In a retrospective analysis of the home medication, 12 definite PIM were identified in 49 elderly patients. CONCLUSION: DRPs are common in the medication of vascular surgery patients and may be improved by pharmacists.

Dynamic cystocolpoproctography is superior to functional pelvic MRI in the diagnosis of posterior pelvic floor disorders: results of a prospective study.

AIM: The accuracy of dynamic cystocolpoproctography (DCP) and dynamic MRI were compared in diagnosing posterior pelvic floor disorders. METHOD: Fifty consecutive female patients (mean age 51 years) complaining of posterior compartment pelvic floor disorder and referred to a tertiary centre entered the prospective study. The Institutional Review Board stated that informed consent from the patients was not necessary for this study. Patients underwent a DCP and a supine functional MRI by two different radiologists. Assessment of radiological examinations was prospective and blind. All patients underwent surgery that led to the final diagnosis. Agreement between the operative diagnosis and the diagnoses following DCP and MRI was assessed using the weighted kappa statistic. A matched-pairs McNemar's test was applied to demonstrate whether or not one radiological method was superior to the other. RESULTS: Full-thickness rectal prolapse was best diagnosed by clinical examination. Internal rectal prolapse and peritoneocele were best diagnosed by DCP. A better agreement with the operative diagnosis, which is not true superiority, was observed for DCP compared with functional pelvic MRI for full-thickness rectal prolapse, internal rectal prolapse and peritoneocele. There was no significant difference between DCP and functional pelvic MRI in the diagnosis of internal rectal prolapse (P = 0.125) or peritoneocele (P = 0.10). CONCLUSION: As full-thickness rectal prolapse, internal rectal prolapse and peritoneocele might be missed by functional pelvic MRI, there should still be a place for DCP in particular cases where the clinical diagnosis is not clear in women with symptomatic posterior pelvic floor disorders.

[MRI-guided targeted prostate biopsies in the diagnosis of prostate cancer: a systematic literature review]. / Biopsies prostatiques ciblées guidées par IRM dans le diagnostic du cancer de prostate : revue de la littérature.

INTRODUCTION: Advances in MRI technology for detection of prostate cancer allow targeted biopsies of suspicious areas. MATERIAL AND METHODS: A systematic literature review was performed on Medline(®) with the keywords "targeted", "prostate biopsy" and related articles. We studied 65 abstracts and 102 related abstracts, read 38 articles and selected 27 articles. RESULTS: Mental reconstruction gives way for targeted biopsies by direct MRI guidance inside the MRI, and MRI-TRUS fusion. The first option offers high precision targeting but is limited by the accessibility, cost and duration of the procedure. MRI-TRUS image fusion is a promising compromise. Cancer detection rates vary from 15 to 64 %. CONCLUSION: Biopsies targeting suspicious areas on MRI are promising to improve the sensitivity and performance of prostate biopsies.

Shot noise in the leaky integrate-and-fire neuron.

We study the influence of noise on the transmission of temporal information by a leaky integrate-and-fire neuron using the theory of shot noise. The model includes a finite number of synapses and has a membrane potential variance de facto modulated by the input signal. The phenomenon of stochastic resonance in spiking neurons is analytically exhibited using an inhomogeneous Poisson process model of the spike trains, and links with the traditional Ornstein-Uhlenbeck process obtained by a diffusion approximation are given. It is shown that the modulated membrane potential variance inherent to the model gives better signal processing capabilities than the diffusion approximation.

[The relationship of maternal obesity, excessive weight gain in pregnancy and pre-eclampsia]. / Beziehungen zwischen Ubergewicht der Mütter, pathologischer Gewichtszunahme in der Schwangerschaft und EPH-Gestose.

The records of 2,671 pregnancies were reviewed regarding maternal obesity, excessive weight gain in pregnancy and pre-eclampsia. Pre-eclampsia is significantly more frequent in maternal obesity. Correlation between excessive weight gain in pregnancy and pre-eclampsia is only found for the signs of edema and hypertension. Edema and excessive weight gain in pregnancy are related to each other, since edema frequently induces the excessive weight gain. Overall, maternal obesity perior to pregnancy is much more important in the development of pre-eclampsia than excessive weight gain during pregnancy.

[Infusion therapy after vaginal hysterectomy (author's transl)]. / Infusionstherapie bei vaginaler Hysterektomie.

The applicability of a complete solution containing amino acids, electrolytes and calories for post-operative infusion therapy after vaginal hysterectomy was investigated. In the 16 patients examined it was found that using this solution it is possible to maintain a smooth nitrogen balance to a large extent. In a control group of 6 patients who only received an infusion of electrolytes and calories, the nitrogen balance was clearly noncompensated. As even with the complete solution compensation of the nitrogen balance is not achieved until the second day, it is recommended that for patients at risk the infusion treatment should be commenced on the day prior to operation.

[Obese patients in obstetrics]. / Ubergewichtige Frauen in der Geburtshilfe

The results of two studies about the course of pregnancy and delivery in adipose women in our hospital are combined and discussed. We found a higher rate of EPH-gestosis in overweight patients. The frequency of Cesarean section was increased. Belated uterine involution post partum is more frequent in adipose women, also the occurrence of urinary tract infections. There is a significant increase in perinatal mortality, mainly due to an increase in still-born. Pneumonia due to aspiration and birth traumata occur more frequently as well and endanger the children.

[Potassium substitutes during tocolysis]. / Kalium-Substitution bei Tokolyse

The level of serum potassium during tokolytic therapy with Partusisten and Isoptin decreases in the first 24 hours of therapy. This decrease is not due to an increase in renal potassium elimination. During tokolytic treatment the serum level of potassium returns to its normal value after 48 hours without potassium substitution. While there is a decrease in serum potassium noticeable changes in electrocardiogram which are typial for hypopotassemia are observed. These changes disappear afer 48 hours of tokolytic treatment but never the less the initial serum potassium drop should be balanced by potassium substitution within these 48 hours.