Frequently acquired drugs in neonatal intensive care and their physical compatibility.

AIM: Incompatibility of intravenous drugs is dangerous and therefore undesirable. The aim of this study was to identify the most commonly acquired intravenous drugs in five neonatal intensive care units and test these for compatibility. METHODS: The most frequently acquired drugs in five key hospitals in the South-Eastern district of Norway for 2019 and 2020 served as a proxy for the prevalence of use. Representatives were selected from the three most prevalent groups based on the Anatomical Therapeutic Chemical classification system. Co-administration of drug pairs was simulated using clinically relevant concentrations and infusion rates representing mixing ratios in the catheter. Particle formation was assessed by particle counting and size measurement, by visual examination using Tyndall beam, by turbidity and by measuring pH of mixed samples. RESULTS: The most frequently acquired drug groups were anti-infectives, neurological agents and cardiovascular drugs. Compatibility testing revealed that both ampicillin and benzylpenicillin were incompatible with morphine. Flecainide and fluconazole showed no signs of incompatibility with morphine. No information on these combinations in a neonatal-relevant setting is available. CONCLUSION: We recommend to abstain from co-administering ampicillin and benzylpenicillin with morphine in neonatal intensive settings. Morphine co-administered with flecainide and fluconazole in neonatal patients were evaluated as safe.

Prescriptions from general practitioners and in hospital physicians requiring pharmacists' interventions.

PURPOSE: To study prescribing errors requiring pharmacists' interventions and to evaluate the potential clinical significance of the errors and omissions detected. METHODS: The pharmacists at ten community pharmacies and two out-patient hospital pharmacies recorded prescribing errors and corresponding interventions using a modified version of a previously developed registration scheme. Prescription errors with potential clinical significance were scored according to a modified version of Safety Assessment Code (SAC)-score RESULTS: During the study period 85,475 prescriptions were dispensed. A total of 2385 prescribing errors were detected on 2226 (2.6%) prescriptions. The proportion of prescriptions with errors and omissions was more than four times higher on prescriptions from hospital physicians (7.1%) than on prescriptions from general practitioners (1.5%). The information on the majority (62.2%) of the prescriptions with inaccuracies had to be clarified before the drug could be dispensed. About 1/4 of the errors and omissions were of potential importance for the drug therapy. An expert panel of physicians and pharmacists judged 85% of these errors and omissions to be clinically significant. Individual physicians and pharmacists judged the clinical importance of the detected prescribing errors somewhat differently. CONCLUSIONS: Pharmacists intervened on 2.6% of prescriptions, and the majority of the potentially clinically significant prescribing errors were judged as significant to the patient's drug therapy and safety.

[Prescription errors--dimension and measures]. / Forskrivningsfeil--omfang og oppklaring.

BACKGROUND: A prescription should contain sufficient information to dispense the right medicine with correct instructions for use. The information given on the prescription also forms the basis for reimbursement of drug expenses. Knowledge of prescription errors may improve the procedures of the prescribing physician and the pharmacy. MATERIAL AND METHOD: Prescriptions without information on the indication of the drug therapy were registered in ten Norwegian pharmacies during two days in the autumn of 2004. Other errors and omissions on prescriptions were registered in nine of the pharmacies during a five week period. RESULTS AND INTERPRETATION: A total of 1884 (39%) of the 4667 prescriptions included in the first part of the study contained no information on the indication. A total of 1696 other errors and omissions were registered on 1359 (2%) of the 69,315 prescriptions included in the second part of the study. The most common errors and omissions were incomplete instructions for use (26%), missing information about the patient (17%), and errors and omissions related to reimbursement of drug expenses. 294 (17%) of the errors were judged to have potential clinical significance if they had not been corrected. The most common intervention was to interview the patient or to contact the prescribing physician. The most common changes were to change or clarify drug and dose.

[Patients' experiences with and attitudes to generic substitution]. / Pasienters erfaringer med og holdninger til generisk legemiddelbytte.

INTRODUCTION: The aim of this study was to assess patient experiences with and attitudes to generic substitution. MATERIAL AND METHODS: Patients who had purchased three to seven, or eight or more, different prescription medicines during the last six months were compared. Both groups were mailed a questionnaire about generic substitution. RESULTS: The response rate was 73% (281/386), the average age of respondents was 66. There was a correlation between patients remembering that information had been provided by their physicians and subsequent generic substitution. Out of 138 patients who had experienced generic substitution, 50 patients (36%) reported one or more negative experiences, 21% an altogether negative experience. About 41% of the patients would not switch given no personal economic insertives. There were no significant correlations between experiences with generic substitution and age, gender, number of different drugs used, information provided by the physician or by the pharmacy staff. INTERPRETATION: About 78% of the patients are satisfied with generic substitution although 1/3 report one or more negative experiences. In order to raise patient satisfaction, there is a need for increased economic incentives and a strategy whereby physicians, pharmacies and official authorities cooperate on information to the public.

UV-Absorbing compounds in the aqueous humor from aquatic mammals and various non-mammalian vertebrates.

OBJECTIVE: To evaluate the absorbance of ultraviolet radiation (UVR) in the aqueous humor of various animal species in relation to the ambient radiation of their respective habitats, and to identify substances responsible for this absorbance. Representatives of all five classes (fish, amphibian, reptile, bird, and mammal) have been tested. METHODS: Absorbance was recorded using a spectrophotometer. The ascorbic and uric acid concentrations were determined by HPLC, and the amino acid profiles with an automatic analyzer. Screening for potential UV-absorbing substances was performed by HPLC and a total of 12 species were examined, 7 of them birds. RESULTS: UV-absorbing substances in the aqueous humor were proteins, tryptophan, tyrosine and ascorbic and uric acid. In addition, an unknown UV-absorbing component present in bird aqueous humor caused a high, red-shifted UV-absorbance spectrum, particularly in tentatively heavily exposed species such as goose when migrating at 10,000 m altitude. By comparison, the UV absorbance above the 288-nm wavelength was low in the aqueous humor of fish, frogs, aquatic mammals and two ground-living birds. The crocodile, whose aqueous humor contained significant amounts of both ascorbic and uric acid, revealed a concentration mechanism for ascorbic acid. CONCLUSIONS: The UV absorbance of aqueous humor varies considerably from one species to the next, and independent of class. It is noteworthy that the species being at highest risk for high-dose UV exposure, the migrating goose, showed the most red-shifted spectrum.

Efficacy of repetitive transcranial magnetic stimulation in depression: a review of the evidence.

Repetitive transcranial magnetic stimulation (rTMS) is a novel treatment in psychiatry. We reviewed all published evidence on the efficacy of this treatment option in depressive disorders. An extensive electronic and manual search for eligible research reports identified only 12 studies that met the predetermined criteria for inclusion. rTMS was administered differently in most studies, and patient characteristics varied widely. A formal meta-analysis of the studies was thus not possible. Instead, we conducted a qualitative evaluation of the included studies. The antidepressive efficacy was not consistent, and where efficacy was demonstrated, it was modest in most studies. Some patients had good but transient responses to rTMS. Treatment gains were not maintained beyond the treatment period. Comparisons with electroconvulsive therapy (ECT) indicated the superiority of ECT. More, larger and more carefully designed studies are needed to demonstrate convincingly a clinically relevant effect of rTMS. We conclude that there is insufficient evidence for rTMS as a valid treatment for depression at present.

Impact of the environment on the mammalian corneal epithelium.

PURPOSE: To evaluate whether the content of ascorbic acid in the corneal epithelium and aqueous humor reflects seasonal fluctuations in parallel with environmental changes. METHODS: Reindeer, cattle, rabbits, and humans were examined, to cover a broad spectrum of overlapping habitats. Ascorbic acid was determined by high-performance liquid chromatography. The thickness of the corneal epithelium was measured, and the number of cells was counted in the tissue sections. RESULTS: Three groups of reindeer eyes were used, two of them collected during summer, the third group during winter. Ascorbate content did not show seasonal variation in either the corneal epithelium or the aqueous humor, whereas epithelial thickness and number of cells decreased significantly from summer to winter. In cattle, ascorbate content, thickness of the epithelium, and number of cells were lower in animals tended indoors compared with those tended outdoors, whereas ascorbate level in the aqueous humor remained similar in both cases. The rabbit showed significantly reduced ascorbate content in the corneal epithelium but not in the aqueous humor in tarsorrhaphy-treated eyes. This procedure did not change epithelial thickness, but the number of cells was slightly increased. The mean epithelial thickness in human corneas successively decreased with increasing latitude and decreasing radiation exposure from the summer season in Oslo to the midnight sun, polar night, conditions in Tromsø, 10 degrees far north, although the differences did not reach statistical significance. CONCLUSIONS: Ambient radiation is needed to sustain high ascorbic acid concentration in the corneal epithelium. Corneal epithelial thickness and number of cells are prone to seasonal fluctuations regulated by ambient radiation. In contrast, ascorbate content of the aqueous humor is uninfluenced by environmental change. It is suggested that seasonal adaptation of mammalian corneal epithelium in response to variation in ambient radiation may be nature's strategy for countering radiation damage to the eye.

Comparison of free amino acids in aqueous humor of farmed and wild salmon and of six species additionally.

OBJECTIVE: A comparative study was performed in order to identify aqueous humor amino acids possibly involved in cataract formation in farmed Atlantic salmon. METHODS: Aqueous humor amino acids from farmed salmons with and without cataract were compared with levels in wild salmon and other animals of different evolutionary levels such as frog, crocodile, turkey, goose, minke whale, and cattle. Serum samples from wild and farmed salmon and minke whale were also analyzed. RESULTS: The total amino acid concentration was lower in aqueous humor obtained from salmon, frog and crocodile compared to birds and mammals. Wild salmon had a higher content of amino acids than farmed salmon. Asparagine was absent in salmon aqueous humor and serum. Aqueous humor proline was readily detectable in wild salmon, birds, whale, and cattle, but not detectable in farmed salmon, frog and crocodile. The aqueous humor concentration of taurine was about seven- and fifty-fold lower compared to serum in wild and farmed salmon, respectively. The corresponding ratio in minke whale was 1:2. CONCLUSIONS: The results indicate a blood- aqueous barrier for taurine in farmed salmon. The lower total amino acid concentration and low aqueous humor proline concentration in farmed salmon should be further investigated.

Preoperative hair removal--a systematic literature review.

This article describes a systematic literature review on whether, how, and when to perform preoperative hair removal. By searching electronic databases and reference lists of relevant articles, team members identified 20 clinical studies that deal with preoperative hair removal. No strong evidence was found to advocate against preoperative hair removal. Furthermore, there was strong evidence to recommend that when hair removal is considered necessary, shaving should not be performed. Instead a depilatory or electric clipping, preferably immediately before surgery, should be used.