Opioid-induced emesis among hospitalized nonsurgical patients: effect on pain and quality of life.

There is very little information in the medical literature regarding opioid-induced emesis and its relationship to patient outcomes. Two-hundred and six nonsurgical patients in a 400-bed teaching hospital with minimal known risks of disease-associated emesis were interviewed to examine emesis and associated outcomes following the administration of opioids for acute pain management. The mean age, weight, and height of the study group were 54.4 (+/- 19.6) years, 175.8 (+/- 45.7) pounds, and 67.1 (+/- 4.4) inches, respectively. Seventy-three (35.4%) patients experienced nausea; 28 (13.6%) patients vomited; and 15 (7.3%) patients retched following the opioid therapy. These symptoms were mild and discomforting for relatively short periods of time. The patients' ability to concentrate and eat was affected by the incidence of nausea/vomiting. The intensity, duration, and severity of nausea were positively associated with the magnitude of the functional limitations. The symptoms also influenced patients' ratings of various hospital satisfaction measures. In conclusion, emesis due to opioids represents a notable burden on nonsurgical patients. Successful therapies that prevent opioid-induced emesis are likely to positively influence patient outcomes by reducing adverse effects, improving functional outcomes, and enhancing quality of life.

Broadening career opportunities in dietetics: employment in independent research.

Independent research organizations provide opportunities for dietetics professionals, along with the interdisciplinary research team, to make an optimal contribution to health care. They also offer a wide variety of career options from principal investigators to study managers. Further, opportunities in progressive independent research organizations often focus on linking research and practical nutritional applications to enhance the dietetics profession. With the shrinking traditional employment market for dietitians, new options must be pursued. Dietitians should consider independent research organizations for an exciting and rewarding career opportunity.

Continuity of care from acute to ambulatory care setting.

Pharmacists' perceptions of a pharmacy-to-pharmacy referral form designed to promote continuity of care for patients being discharged from a hospital were studied. Patients being discharged from a nonteaching, tertiary care hospital to a private residence and having at least one prescription for a new medication were invited to participate in the study. A pharmacy-to-pharmacy referral form was completed on the basis of each patient's medical record and discharge orders. Patients were provided with a copy of the form and told to give it to their community pharmacist with their discharge prescriptions; an additional copy was mailed the same day to the pharmacy. The pharmacist was instructed to telephone the hospital pharmacy on receipt of the form to schedule a telephone interview. A total of 127 patients were enrolled in the study; the average number of discharge medications per patient was 4.8. A total of 120 interviews were conducted with 91 community or ambulatory care pharmacists. In 102 cases (85%), the pharmacists indicated that the referral form provided information that resulted in a benefit to the patient through indication-specific counseling. In 104 cases (87%), pharmacists indicated that the form provided information that had a positive impact on patient-pharmacist interactions, and 75 interviews (62%) indicated that pharmacists were able to incorporate the information into a database to direct future patient care. Community and ambulatory care pharmacists who received information from hospital pharmacists about patients being discharged from the hospital reported that the information aided in patient care.

Effect of energy source and escape protein on receiving and finishing performance and health of calves.

Two receiving and two finishing trials evaluated energy source and escape protein supplementation for calves. In receiving Trial 1, 398 calves (257 +/- 24 kg BW) were used in a 2 x 2 factorial arrangement of treatments. Energy sources were dry-rolled corn (DRC) and wet corn gluten feed (WCGF); each was fed without or with supplemental escape protein (EP). Calves fed WCGF gained slower (P < .05) and consumed less DM (P < .01) than calves fed DRC. Feed efficiency improved (P < .10) with EP supplementation. In finishing Trial 1, 240 calves (305 +/- 21 kg BW) were used. The arrangement of treatments was the same as in receiving Trial 1. Calves fed DRC/WCGF tended (P = .15) to be more efficient and consumed less DM (P < .05) than calves fed DRC. In receiving Trial 2, 315 calves (252 +/- 23 kg BW) were fed diets similar to those fed in receiving Trial 1. Calves fed WCGF consumed less DM (P < .01), gained similarly (P > .15), and were more efficient (P < .10) than calves fed DRC. In finishing Trial 2, 320 calves (298 +/- 23 kg BW) were fed diets containing DRC, DRC/WCGF, high-moisture corn (HMC), HMC/WCGF, and DRC/HMC; each was fed without or with supplemental EP. An energy source x protein supplement interaction was detected for gain (P < .05) and efficiency (P < .01). Results suggest that WCGF has a NEg greater than DRC in receiving diets and a NEg similar to that of DRC but lower than that of HMC in finishing diets.

T lymphocyte beta 2-adrenergic receptor function and density after acute myocardial infarction.

The T lymphocyte beta 2-adrenergic receptor (beta 2AR) density and function were compared in 15 patients suffering acute myocardial infarction and 10 patients with stable coronary artery disease (CAD). Density was determined using radioligand binding with 125IPIN, and function by in vitro cyclic adenosine 3',5'-monophosphate (cAMP) production. In patients suffering acute myocardial infarction, T lymphocyte beta 2AR density (823.8 +/- 480 sites/cell) was slightly but not significantly different from that in patients with stable CAD (629 +/- 301 sites/cell). There was no difference in T lymphocyte cAMP production at baseline (1.11 +/- 0.70 vs 1.04 +/- 0.49 pM/10(6) cells) or after isoproterenol stimulation (2.53 +/- 1.63 vs 2.62 +/- 2.05 pM/10(6) cells), respectively. Further study is necessary to determine if beta 2AR numbers on T lymphocytes are significantly increased after acute myocardial infarction.

Influence of grain type, tallow level, and tallow feeding system on feedlot cattle performance.

Two experiments were conducted to evaluate the effects of grain type, tallow level, and tallow feeding system on finishing steer performance. Experiment 1 involved 256 yearling steers (359 kg) in a 4 x 2 factorial arrangement of treatments. Steers were assigned randomly to one of four tallow feeding systems: 1) 0% tallow fed throughout the experiment; 2) 4% tallow fed throughout the experiment; 3) 0% tallow fed d 1 through 33 and then 4% tallow fed until slaughter; and 4) 4% tallow fed d 1 through 33 and then 0% tallow fed until slaughter. Tallow treatments were applied to diets containing either dry-rolled corn (DRC) of high-moisture corn (HMC). No fat treatment x grain type interaction (P > .10) was observed. Steers fed 4% tallow throughout the experiment, only during d 1 through 33, or only during d 34 until slaughter were more (P < .10) efficient than steers fed 0% tallow. No differences in DMI or ADG were observed (P > .10). In Exp. 2, 120 large-framed steer calves (286 kg) were blocked by weight and allotted randomly within block to one of three treatments consisting of the addition fo 0, 2, or 4% tallow added d 1 and fed for 197 d. Feed efficiency of calves increased linearly (P < .05) with increasing tallow level. Daily gain was not different (P > .10), but DMI decreased linearly (P < .05) with increasing tallow level. This research indicates that tallow added during or after grain adaptation to DRC- or HMC-based diets fed to yearling steers will result in similar improvement in feed efficiency, and that including up to 4% tallow to diets fed to large-framed calves can significantly improve feed efficiency.

Effect of level and type of fat on subacute acidosis in cattle fed dry-rolled corn finishing diets.

Five experiments were conducted to determine the effect of fat addition to dry-rolled corn (DRC) finishing diets on subacute acidosis. In Exp. 1, five ruminally fistulated steers (410 +/- 12 kg BW) were used in a 5 x 5 Latin square design. Treatments consisted of 0, 2, 4, 6, or 8% tallow added to a 50% fine-ground corn: 50% dry-rolled wheat basal challenge diet and dosed intraruminally as an acidosis challenge. Area below pH 6 was determined to quantify the total decrease in ruminal pH over a 24-h period. Area below pH 6 responded quadratically (P < .05); greatest time below pH 6 occurred with diets containing 2, 4, and 6% tallow. In Exp. 2, six ruminally fistulated steers (527 +/- 47 kg BW) were used in a 6 x 6 Latin square design and intraruminally dosed with 0, 4, 6, or 8% tallow or 4 or 8% yellow grease added to a 50% fine-ground corn:50% dry-rolled wheat basal challenge diet. Area below pH 6 responded quadratically for both tallow (P = .10) and yellow grease (P < .05) and was greatest for steers dosed with 4% tallow or yellow grease and decreased as tallow or yellow grease increased from 4 to 8%. Experiment 3 was a metabolism study using six ruminally fistulated steers (469 +/- 68 kg BW) in a 6 x 6 Latin square design. Cattle were fed a DRC finishing diet containing 0, 4, 6, or 8% tallow or 4 or 8% yellow grease.(ABSTRACT TRUNCATED AT 250 WORDS)

Reliability of blood pressure, heart rate, and Doppler-derived hemodynamic measurements during exercise.

Doppler echocardiography of aortic blood flow, heart rate, and blood pressure represent noninvasive methods for evaluation of the hemodynamic effects of pharmacologic agents or other stimuli during rest and exercise. In this study the reliability of continuous-wave Doppler echocardiography for detecting the effects of various interventions on left ventricular systolic function during exercise was assessed. The reliability of Doppler measurements was compared with that found for measurements of simultaneously obtained heart rate and blood pressure. Exercise treadmill testing was performed at 0, 2, 4, 6, and 8 hours in 18 healthy male subjects. All measurements were performed at rest and during the last half of each exercise stage. Reliability of peak modal velocity, peak aortic blood flow acceleration, heart rate, and blood pressure was measured by the intraclass correlation coefficient (ICC) at each stage. ICC reliability of greater than 0.75 is considered excellent, 0.4 to 0.75 fair to good, and less than 0.4 poor. The reliability of all Doppler-derived parameters, heart rate, and blood pressure improved with increasing stage of exercise. Peak modal velocity, peak acceleration, heart rate, and manually obtained systolic blood pressure had ICCs of 0.75 or greater by stage 3. The reliability of Doppler-derived aortic blood flow parameters was good or excellent at rest and advanced stages of exercise. Continuous-wave Doppler echocardiography is a reliable method for performing studies to assess the effects of interventions on cardiovascular function during exercise.

Effect of nebulized albuterol on serum potassium and cardiac rhythm in patients with asthma or chronic obstructive pulmonary disease.

STUDY OBJECTIVE: To evaluate the metabolic and cardiopulmonary effects of nebulized albuterol in patients suffering moderate to severe exacerbations of asthma or chronic obstructive pulmonary disease. DESIGN: Open-label, prospective study. SETTING: The emergency department of a university medical center. PATIENTS: Ten patients with moderate to severe exacerbation of asthma. INTERVENTIONS: Each patient received nebulized albuterol 2.5 mg for approximately 10 minutes. MEASUREMENTS AND MAIN RESULTS: Serum potassium, heart rate and rhythm, blood pressure, and pulmonary function were measured before treatment and every 15 minutes for 2 hours after treatment. Serum potassium concentrations decreased significantly (p < 0.05) within 75 minutes after initiation of treatment, from a baseline value of 4.5 +/- 0.6 mEq/L (range 3.5-5.5 mEq/L) to 3.7 +/- 0.5 mEq/L (range 2.8-4.4 mEq/L) at the end of the collection period (120 minutes). Forced expiratory volume in 1 second significantly increased over time in patients with asthma (p < 0.05). No statistically significant changes in blood pressure, heart rate, or corrected QT intervals occurred. Pre-emergency department use of a beta 2-agonist by metered-dose inhaler was not associated with a decreased serum potassium on admission. CONCLUSIONS: Nebulized beta 2-agonists are generally efficacious and safe in patients with acute bronchospasms. However, close monitoring of serum electrolytes, heart rate, and rhythm in patients at risk (elderly, those with pre-existing cardiac disease) is advised before these individuals receive repeat doses by continuous aerosol administration.

Pharmacodynamics of racemic and S(-)-atenolol in humans.

The cardiovascular actions of racemic atenolol (RSATN) have been well characterized in humans, but the actions of S(-)-atenolol (SATN) when administered alone are unknown. In this study, responses of heart rate (HR) and Doppler-derived aortic blood flow profiles to upright treadmill exercise were compared after oral administration of 50 mg SATN and 100 mg RSATN in eight healthy, adult, male volunteers. After a single-blind, placebo run-in period, subjects were randomly allocated in a double-blind, crossover fashion to receive SATN and RSATN. Each study period was separated by a 7-day washout period. Multiple submaximal exercise tests were performed and data were collected over the 24 hours after each treatment. Both SATN and RSATN significantly (P < .05) blunted peak exercise HR by 38 +/- 3 and 37 +/- 3 beats/min, respectively. Aortic blood flow acceleration measured during peak exercise decreased after SATN and RSATN, by 13 +/- 4 and 13 +/- 3 m/sec2, respectively (P < .05). No difference in hemodynamic effect was observed between treatments. Pharmacodynamic parameters derived from plasma S(-)-atenolol concentration-effect (HR) curves after SATN, RSATN, and total atenolol plasma concentrations after RSATN did not differ significantly. Predicted maximum reductions in heart rate (Emax) and EC50 for S(-)-atenolol after SATN were 39.6 +/- 5.8 beats/min and 38.4 +/- 40.9 ng/ml versus 34.5 +/- 8 beats/min and 25.9 +/- 29.9 ng/ml for RSATN, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Single dose pharmacokinetics of (S)-atenolol administered orally as a single enantiomer formulation and as a racemic mixture (Tenormin).

The purpose of this study was to describe the pharmacokinetics of and heart rate and blood pressure responses to (S)-atenolol (SATN) and (R)-atenolol (RATN) after oral administration of (S)-atenolol and (R,S)-atenolol (Tenormin) in man. Eight male subjects were given single oral doses of 50 mg of SATN as a single enantiomer formulation (SEF) and 100 mg of Tenormin (TMN) using a randomized, double-blind, 2-period, complete crossover study design. Subjects performed exercise tolerance tests (Bruce Protocol) before and 2, 4, 6, 8, 12, and 24 h after drug administration. Plasma samples were obtained 2 min before and 30 min, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, and 24 h after dosing. Urine was collected for the first 48 h after dosing. Plasma and urine samples were analyzed for SATN and RATN by an enantioselective HPLC method. SEF and Tenormin attenuate exercise-induced increases in heart rate and systolic blood pressure. Mean changes in exercise heart rates 4 h after dosing were -38 +/- 3 bpm and -37 +/- 3 bpm for SEF and TMN, respectively, P = 0.792. Mean changes in exercise systolic blood pressure were -42 +/- 12 mm Hg and -55 +/- 14 mm Hg for SEF and TMN, respectively, P = 0.484. Mean area under the plasma level time curve (AUC0-24) and mean Cmax for SATN for SEF were significantly lower than for SATN after TMN.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy of 1.4 percent sodium citrate in maintaining arterial catheter patency in patients in a medical ICU.

PURPOSE: The primary purpose of this study was to compare the efficacy of 1.4 percent sodium citrate with heparin, 4 U/ml, for maintaining radial artery catheter patency in patients in the medical ICU. PATIENTS AND METHODS: Patients in the medical ICU (n = 40) were randomized to either a 1.4 percent sodium citrate or heparin 4 U/ml arterial line flush solution in a double-blind, parallel fashion. The flush solutions were continuously infused at approximately 3 ml/h over a maximum of 96 h. Catheter survival rates were compared using Kaplan-Meier survival curves. The frequency of catheter malfunctions and corrective manipulations were recorded and compared. Coagulation status (APTT, PT) and ionized calcium values were monitored to evaluate the systemic effects of sodium citrate. RESULTS: Ninety-four percent of catheters flushed with sodium citrate were functional at 48 h compared with 88 percent for heparin (p > 0.05). At 96 h, 80 percent vs 88 percent of the catheters were functional in the citrate and heparin groups, respectively (p > 0.05). Frequency of catheter malfunctions did not differ between the two groups. No systemic effects of sodium citrate were observed. CONCLUSION: Arterial catheter flush solutions containing sodium citrate (1.4 percent) are an effective and safe alternative to heparin in patients requiring peripheral arterial catheterization.

Differential response of beta-adrenergic receptor-mediated heart rate and aortic blood flow acceleration to timolol.

The apparent affinity of beta-adrenergic receptors for timolol in the sinus node and ventricular myocardium was compared in 11 normal male subjects. Sinus nodal function was assessed by heart rate, and left ventricular systolic function was assessed by Doppler-derived aortic blood flow acceleration. The dose of isoproterenol required for a heart rate or acceleration increase of 35% (I35) was determined before and 2 hours after an oral 10 mg dose of timolol. The apparent affinity constant (ka) for timolol binding to the receptor was calculated from the serum timolol concentration and the ratio of the I35 after timolol/I35 before timolol. The I35 for sinus node and ventricular myocardium were not significantly different from one another. The ka for timolol binding to the sinus node (1.14 x 10(6) mol/L), however, was significantly greater (p less than 0.05) than ka for ventricular myocardium (7.85 x 10(5) mol/L). These findings suggest that beta-adrenergic receptors in the sinus node may have an overall greater affinity for beta-blocking agents than do receptors in the ventricular myocardium.