Knotless anchors with sutures external to the anchor body may be at risk for suture cutting through osteopenic bone.

OBJECTIVES: This study evaluated the mechanical performance, under low-load cyclic loading, of two different knotless suture anchor designs: sutures completely internal to the anchor body (SpeedScrew) and sutures external to the anchor body and adjacent to bone (MultiFIX P). METHODS: Using standard suture loops pulled in-line with the rotator cuff (approximately 60°), anchors were tested in cadaveric bone and foam blocks representing normal to osteopenic bone. Mechanical testing included preloading to 10 N and cyclic loading for 500 cycles from 10 N to 60 N at 60 mm/min. The parameters evaluated were initial displacement, cyclic displacement and number of cycles and load at 3 mm displacement relative to preload. Video recording throughout testing documented the predominant source of suture displacement and the distance of 'suture cutting through bone'. RESULTS: In cadaveric bone and foam blocks, MultiFIX P anchors had significantly greater initial displacement, and lower number of cycles and lower load at 3 mm displacement than SpeedScrew anchors. Video analysis revealed 'suture cutting through bone' as the predominant source of suture displacement in cadaveric bone (qualitative) and greater 'suture cutting through bone' comparing MultiFIX P with SpeedScrew anchors in foam blocks (quantitative). The greater suture displacement in MultiFIX P anchors was predominantly from suture cutting through bone, which was enhanced in an osteopenic bone model. CONCLUSIONS: Anchors with sutures external to the anchor body are at risk for suture cutting through bone since the suture eyelet is at the distal tip of the implant and the suture directly abrades against the bone edge during cyclic loading. Suture cutting through bone may be a significant source of fixation failure, particularly in osteopenic bone.Cite this article: Y. Ono, J. M. Woodmass, A. A. Nelson, R. S. Boorman, G. M. Thornton, I. K. Y. Lo. Knotless anchors with sutures external to the anchor body may be at risk for suture cutting through osteopenic bone. Bone Joint Res 2016;5:269-275. DOI: 10.1302/2046-3758.56.2000535.

An exploratory analysis of consumer recognition of direct-to-consumer advertising of prescription medications.

Consumer knowledge of direct-to-consumer prescription drug advertising was explored by assessing consumer recognition of the direct advertising of Pneumovax by Merck, Sharp and Dohme. Consumer attitudes, medical condition, and demographic characteristics were the central issues of the survey instrument used in the 139 personal interviews conducted. Results indicate 12% of consumers were aware of the Pneumovax promotion. Consumer attitudes were favorable, and the majority of respondents indicated they would ask their physician about advertised prescription medicines.

Amine trapping: physical explanation for the inhibitory effect of gastric acidity on the postprandial release of gastrin. Studies on rats and dogs.

We investigated the relationship between the pH dependence of meal-stimulated gastrin release and the permeability of the antral mucosa to dietary amines. This study was undertaken after previous work from our laboratory had demonstrated that dietary amines are potent in vivo and in vitro stimulants of gastrin release and that it is well established that amines are trapped in acidic environments. Three contrasting experimental model systems were employed to investigate the association of these two pH-dependent properties. In the first in vivo study, it was demonstrated that ingestion of standard rat Chow resulted in an increase in circulating gastrin and ammonia levels, whereas the postprandial increases in both properties were abolished if the rats ingested Chow that was preacidified to a pH of 2.4. Second, the antral uptake of the fluorescent cyclic amine, quinacrine, from the gastric lumen of pylorus-ligated rats was monitored by fluorescent microscopy and spectrophotometry and was demonstrated to be inhibited in a step-wise fashion as the luminal pH was decreased. Lastly, our in vitro studies suggested that the transport of [14C]methylamine into canine antral mucosa mounted in Ussing chambers was pH-dependent, as was gastrin release into the incubation medium. Thus, all the data are consistent with the possibility that meal-stimulated gastrin release is inhibited at low pH, due (in part) to the protonation of dietary amines, preventing their diffusion into the G cell to activate hormone secretion.

Validating the nursing diagnosis of impaired physical mobility.

The lack of research-based literature and of research models for validating nursing diagnoses results in some ambiguity in research efforts. Research must, however, move forward if there is to be progress in differentiating nursing and medical diagnostic models and use of nursing diagnoses to improve communication among nurses. Operational definitions of nursing diagnosis terminology are essential to continue work in validating nursing diagnoses, particularly in the clinical setting. The diagnosis impaired physical mobility was found to be an appropriate diagnosis for rehabilitation patients. Continued study and refinement of etiologies and defining characteristics is needed.

The differential impact of copayment on drug use in a Medicaid population.

In this study of the influence of copayment on drug utilization, we examined the prescription experience of 10 categories of drugs used by Medicaid beneficiaries in South Carolina over a four-year period. We observed an immediate and significant effect of copayment on the level of expenditures for all drug categories except analgesics and sedative/hypnotic drugs. The impact of copayment on the changes in the slopes of the series was not as dramatic. Only expenditures for cardiovascular, cholinergic, diuretic, and psychotherapeutic agents demonstrated a significant change in the long-term trend. We conclude that the imposition of a copayment for prescription services exerted a differential effect among therapeutic categories.

Clinical pharmaceutical services in retail practice. I. Pharmacists' willingness and abilities to provide services.

The expansion of service levels in traditional community pharmacies in the face of structural and process impediments as well as the lack of reinforcement that would be provided by demand and reimbursement for such services requires a highly dedicated professional. As a result, this research had the goals of investigating the relationship between service provision and pharmacist willingness and competency, and characterizing pharmacists who presently do or do not provide expanded levels of service. A census of South Carolina community pharmacists was carried out using a self-administered, mail questionnaire. Analysis of the 890 responses representing 63.4 percent of the sample revealed that there is a significant relationship between pharmacists' willingness and ability and the extent to which they provide expanded levels of service. Pharmacists providing services were not only more willing and able to do so, but worked longer hours, tended to work in apothecary or independent pharmacies, held advanced degrees, and were more involved in continuing education. The results generally support the hypothesis that both willingness and competency may serve as barriers to the extension of clinical services into traditional community pharmacy settings.

Rapid covalent coupling of proteins to cell surfaces: immunological characterization of viable protein-cell conjugates.

A rapid and efficient 2-step procedure is described for covalently attaching proteins to cell surfaces by using a heterobifunctional cross-linking agent, succinimidyl-4-(N-maleimidomethylcyclohexane)-1-carboxylate (SMCC). In the first step, protein is derivatized for about 30 min with a 1:1 (mole:mole) stoichiometric ratio of SMCC which creates 4-(N-maleimidomethylcyclohexane)-1-amidyl-protein (MCA-protein) covalent linkages with the primary amino groups of proteins. In the second step, cell-MCA-protein conjugates are rapidly prepared (in less than 30 min) by reacting MCA-protein with 'reduced' cells which have been pre-incubated (for about 1 h) with dithiothreitol (DTT). Stable protein-cell conjugates result from the covalent thioether linkages formed between the maleimido groups of the derivatized protein and the cell surface thiol groups created by DTT reduction. Protein-cell conjugates have been made in this way with several different proteins using several different types of cells. Such conjugates are characterized in this study by complement plus antibody-mediated cytotoxicity (CAMC) and by antibody-dependent cellular cytotoxicity (ADCC) with human effector lymphocytes. Because these protein-cell conjugates are shown to remain viable and to retain significant levels of coupled protein for at least 24 h in culture, they are potentially useful for probing various membrane-related phenomena such as the recognition of cell surface antigens by immune effector cells.

The effect of a Medicaid drug copayment program on the utilization and cost of prescription services.

The effect of a copayment for pharmaceutical services in a Medicaid program is presented. Data were collected from Medicaid claim files in South Carolina (experimental program) and Tennessee (control program) for a 4-year period, 1976-1979. Utilization rates and expenditures for 1 year prior to copayment and 3 years after copayment were computed from a stratified sample of 18 counties. Both the level of prescriptions per eligible recipient and the slope of the utilization function after copayment were found to have declined with the implementation of copayment in South Carolina. The level of the expenditure series after copayment also declined, but the series retained a positive trend. Subsequent analysis of prescription quantity concluded that the increasing expenditure function was attributed to the inflation in cost of ingredients rather than an increase in average prescription size. The study concluded that a small (50) copayment for prescription service is a successful mechanism to control the cost and assist in financing a Medicaid prescription drug program.

Effect of patient recognition of tranquilizers on their use in alcohol detoxification.

The effect of patient recognition of tranquilizing agents on patient requests for tranquilizers during detoxification treatment was evaluated. A total of 120 subjects, all patients at a detoxification unit, were randomly assigned to four groups: diazepam 10 mg in its commercially available form, diazepam 10 mg masked in opaque capsules, hydroxyzine pamoate 50 mg in its commercially available form, and hydroxyzine pamoate 50 mg masked in opaque capsules. Tranquilizers were administered only on patient request, and the time and date of each request were recorded. Subjects were interviewed about previous tranquilizer use and recognition of tranquilizing agents. They also completed a state-trait anxiety inventory. Patient records were reviewed to obtain basic demographic data. Although requests and recognition were higher in those subjects in the diazepam groups, the differences between the two groups were not significant. However, there was a positive relationship between requests for diazepam among those who recognized their medications, and administering the medications in opaque capsules significantly reduced the number of requests for both drugs. Anxiety scores and previous drug therapy were found to be significantly related to recognition and the average number of requests. There was a positive relationship between recognition of and requests for a tranquilizer. Clinicians should consider giving patients with a tendency to abuse drugs nonidentifiable dosage forms.

Task and cost analysis of integrated clinical pharmacy services in private family practice centers.

Costs and activities required for the provision of integrated clinical pharmacy services were examined in private family medicine centers in rural South Carolina. Work sampling and financial data for a one-year period were merged, yielding an average clinical service cost of $1.65 per center patient visit. Pharmacists in family medicine environments spent almost twice the amount of time in clinical activities as has been shown in studies of their colleagues in chain store environments, and one half as much time in prescription-dispensing activities. A greater proportion of the former's workday was also spent in communication with patients. Costs for prescriptions dispensed in these rural centers combined with the average national net profit per prescription yielded a total cost that was within a few cents of the national average. Hence, costs can be controlled to the extent that maintenance of a competitive prescription-pricing policy is possible. Integration of clinical pharmacy services in family practice centers appears to be an economically viable practice model.

Interpretation of research data: regression analysis.

The types of problems that can be analyzed with regression analysis, and interpretation of the resulting summary statistics, are discussed. Linear and multiple regression models, regression coefficients are described. Regression analysis can answer questions about the existence and strength of relationships and the relative importance of independent variables, and can forecast the outcome from changes in the values of independent variables. Multivariate regression analysis can detect the contribution of each of several independent variables on the dependent variable.

Practice patterns of male and female pharmacists.

A survey was undertaken using sample alumni of the University of South Carolina College of Pharmacy and the Philadelphia College of Pharmacy and Science to attempt to determine practice parameters of male and female pharmacists. The study included male and female graduates during an 18-year period from 1961 through 1978. Data are presented relating sex to practice interruptions and the characteristics exhibited thereof. The results disclosed that 126 (34.7%) of the female and 21 (8.4%) of the male practitioners had interrupted their practices at one time or another following graduation. Furthermore, 88.8% of all practice interruptions among females was found to be linked to familial obligations.

Copayment for pharmaceutical services in a Medicaid program.

Copayment for prescription drugs in a Medicaid drug program is an increasingly popular mechanism to finance dispensing fee increases. There is, however, reason to expect such a provision to alter physician prescribing habits. Furthermore, the copayment, although small in dollar amount, may create an economic barrier to indigent program recipients obtaining the necessary medication to maintain their well-being. A sample of pharmacy providers in the South Carolina Medicaid drug program was surveyed to ascertain their perspective toward the copayment provision. The response rate from the 200 randomly chosen practitioners was 91%. The theory that copayment creates an economic barrier to the consumption of necessary pharmaceuticals could not be supported. However, providers in high volume Medicaid pharmacies reported physicians altered their prescribing behavior to prescribe a larger quantity of doses per prescription. In general, pharmacists reported a high degree of satisfaction with the copayment provision.

Effect of pharmacist consultation on rational antimicrobial therapy.

The incidence of rational decisions concerning antimicorbial therapy before and after the establishment of clinical pharmaceutical services in a hospital was compared. A protocol was designed to determine the rationality of physician orders for antimicrobial therapy. This ptocol was used to analyze retrospectively the medical records for patients admitted to a 30-bed surgical unit and a 30-bed medical unit during two months before and after clinical pharmaceutical services were initiated. The results showed that exposure to routine clinical pharmaceutical services appeared to improve prescribing rationality only of drugs used to treat infectious conditions. Since the study design had no control group, the causal effect of clinical pharmaceutical services on the rationality of antimicrobial therapy could not be determined; however, the use of an organized protocol in monitoring antimicrobial therapy allowed an assessment of the use and misuse of antimicrobials in hospitals.