Involvement of a pharmacy department in a hospital's transition to patient-centered care.

This article will describe our hospital's transition to a patient-centered care environment as a response to rising costs within the hospitals and a desire to improve the quality of patient care through systems improvement. The involvement of pharmacy managers in the new organizational structure will be detailed, as well as their new roles and responsibilities as care center leaders. The traditional pharmacy management structure has been replaced by a team approach to decision making and problem solving. Challenges exist to the pharmacy managers as they reorganize to accommodate new responsibilities within the care centers. Opportunities exist within this setting to support pharmaceutical care.

Relationship between pain severity and serum beta-endorphin levels in postoperative patients.

STUDY OBJECTIVE: To examine the relationship among postoperative pain severity, serum beta-endorphin level, and serum morphine level in pediatric patients after posterior spinal fusion with instrumentation. DESIGN: A prospective study. SETTING: University-based medical center. PATIENTS: Ten patients age 13-17 years admitted for posterior spinal fusion with instrumentation. INTERVENTIONS: Each subject was administered an initial dose of intravenous morphine 100 micrograms/kg, followed by a constant infusion of 50 micrograms/kg/hour. The primary physician was allowed to titrate the dosage as required to meet the patient's requirement for analgesia. Whole blood was obtained for the analysis of serum morphine and beta-endorphin levels preoperatively, after the initial morphine dose, 24 hours after initiation of the infusion, and before any change in dosage. At each blood sampling time, pain severity ratings were obtained from the subject, nurse, and parent using a 10-point linear scale. MEASUREMENTS AND MAIN RESULTS: No statistical difference between serum beta-endorphin values preoperatively and after the initial dose of morphine was observed; mean values were 68 and 60 pg/ml, respectively. The relationships between serum beta-endorphin level and pain scores were statistically significant only for self (subject) pain scores (p = 0.014, r = 0.30). Mean serum morphine level was 21.9 ng/ml for patients with self pain scores of 4 or less. CONCLUSION: The clinical usefulness of serum beta-endorphin as a measure of pain severity was not established under the experimental conditions of this study.

Effect of proteolytic cleavage on functional properties of muscarinic acetylcholine receptors in rat pancreatic and parotid acinar cells.

Muscarinic acetylcholine receptors in isolated rat pancreatic acinar cells have an apparent Mr of 88 000, which could be decreased to 46 000 by papain, as deduced by covalent binding of the specific alkylating agent [3H]propylbenzilylcholine mustard. Muscarinic receptors on papain-treated acinar cells retained the antagonist-binding site and both high- and low-affinity binding sites for the cholinergic agonist carbachol. Similar results were observed in studies with rat parotid acinar cells, although the receptors in both control and papain-treated cells were each 10 000-15 000 Da smaller than in pancreas. Additionally, muscarinic receptors in papain-treated pancreatic acinar cells retained the ability to mediate carbachol stimulation of digestive-enzyme secretion. These results demonstrate that the characteristic binding properties of muscarinic receptors for both agonists and antagonists as well as their ability to translate agonist occupancy into a physiological response are not altered by proteolytic cleavage.

Correlation of serum cyclosporine concentration with renal dysfunction in marrow transplant recipients.

We retrospectively analyzed the relationship of serum cyclosporine concentration to renal dysfunction in 63 marrow transplant recipients who received cyclosporine for prophylaxis of acute graft-versus-host disease. Patients were divided into three groups according to their mean trough cyclosporine concentration for the first 28 days of therapy: less than 150, 150-250, and greater than 250 ng/ml. Baseline renal function and exposure to nephrotoxic antibiotics was comparable in the three groups. Renal dysfunction was defined as doubling of baseline serum creatinine. The likelihood of developing renal dysfunction was analyzed with Kaplan-Meier product limit estimates. The log-rank test was used to compare the three groups. Fifty-four (86%) of the patients developed renal dysfunction. The incidence of renal dysfunction was 73%, 95%, and 100%, and it developed at a median of 46, 29, and 20 days in patients with a mean trough concentration of less than 150, 150-250, and greater than 250 ng/ml, respectively (P less than 0.001). Eight of the nine patients who did not develop renal dysfunction had a mean trough concentration of less than 150 ng/ml. These data indicate that the incidence and the rate of development of renal dysfunction are related to serum cyclosporine concentration.

Muscarinic acetylcholine receptor structure in acinar cells of mammalian exocrine glands.

Characterization of muscarinic acetylcholine receptors in acinar cells from rat pancreas and lacrimal and parotid glands was achieved by binding of the reversible muscarinic antagonist [3H]quinuclidinyl benzilate (QNB) and the specific alkylating reagent [3H]propylbenzilylcholine mustard (PrBCM) to intact acini or dispersed acinar cells. Binding studies with [3H]QNB showed that acinar cells from pancreas contain 26,400, from parotid 21,400, and from lacrimal gland 25,700 binding sites/cell. To assess molecular size of the receptor in each gland, acini were prepared by digestion with purified collagenase and singly dispersed acinar cells were prepared by a combination of digestion with crude collagenase, hyaluronidase, and alpha-chymotrypsin and divalent cation chelation using EDTA. Muscarinic receptors on acini or dispersed cells were covalently labeled with 5 nM [3H]PrBCM, solubilized directly in hot sodium dodecyl sulfate buffer, and resolved by polyacrylamide gel electrophoresis. When solubilized acini were electrophoresed, a major labeled peak was observed on gels along with a smaller peak of lower apparent molecular weight. For pancreatic acini, the apparent molecular weights of these peaks were 117,600 and 85,700; for parotid acini, 104,800 and 74,500; and for lacrimal acini, 87,200 and 63,100. Addition of muscarinic antagonists to the labeling medium abolished both peaks. When dispersed acinar cells were labeled, the larger peak was eliminated, and all radioactivity was concentrated in a single peak: 87,600 for pancreas, 78,000 for parotid gland, and 62,800 for lacrimal gland. Digestion of prelabeled acini with the mixture of enzymes used to produce dispersed acinar cells similarly shifted all radioactivity into this second peak. Limited digestion of acini or dispersed cells with 1 mg/ml of papain resulted in the disappearance of these higher molecular weight peaks and the appearance of a broad peak at Mr = 40,000. Cells of nonepithelial origin, IM-9 lymphocytes and NG108 neuroblastoma X glioma hybrids, also were labeled with [3H]PrBCM and electrophoresed.(ABSTRACT TRUNCATED AT 250 WORDS)