Tolerability of oral sorafenib in pet dogs with a diagnosis of cancer.

Sorafenib is a multi-target small molecule inhibitor of the RAF kinase family and VEGFR-2/PDGFR. The US Food and Drug Administration approved sorafenib in human patients with liver, thyroid, or renal carcinoma. The aim of this study was to help guide future pharmacokinetic (PK) studies of sorafenib in dogs with a cancer diagnosis. Client-owned dogs were eligible if they had a cytologic or histologic diagnosis of cancer. Patients were enrolled at escalating doses of sorafenib. Patients were evaluable for the study if they received at least one dose of sorafenib and presented 1 week later for a follow-up examination, blood work, and assessment of drug tolerability. The goal of this study was not to define a maximum tolerated dose as may be reasonable in conventional cytotoxic chemotherapy drugs, but rather to describe the tolerability of this drug in dogs with a cancer diagnosis, as a prequel to future sorafenib PK studies. No patients in the study had any evidence of adverse events that were attributable to sorafenib. Doses of 3 mg/kg were well tolerated and associated with a suggestion of clinical activity, supportive of future PK, and pharmacodynamic analysis. Such future studies are recommended at this dose to define the associated exposure achieved and determine a reasonable schedule for sorafenib administration.

Lamellar and liquid crystal ordering in solvent-annealed all-conjugated block copolymers.

All-conjugated block copolymers are an emerging class of polymeric materials promising for organic electronic applications, but further progress requires a better understanding of their microstructure including crystallinity and self-assembly through micro-phase segregation. Here, we demonstrate remarkable changes in the thin film structure of a model series of all-conjugated block copolymers with varying processing conditions. Under thermal annealing, poly(3-hexylthiophene)-b-poly(9',9'-dioctylfluorene) (P3HT-b-PF) all-conjugated block copolymers exhibit crystalline features of P3HT or PF, depending on the block ratio, and poor π-π stacking. Under chloroform solvent annealing, the block copolymers exhibit lamellar ordering, as evidenced by multiple reflections in grazing incidence wide- and small-angle X-ray scattering (GIWAXS and GISAXS), including an in-plane reflection indicative of order along the π-π stacking direction for both P3HT and PF blocks. The lamellae have a characteristic domain size of 4.2 nm, and this domain size is found to be independent of block copolymer molecular weight and block ratio. This suggests that lamellar self-assembly arises due to a combination of polymer block segregation and π-π stacking of both P3HT and PF polymer blocks. Strategies for predicting the microstructure of all-conjugated block copolymers must take into account intermolecular π-π stacking and liquid crystalline interactions not typically found in flexible coil block copolymers.

Improved bed use with creation of a short-stay unit in a cardiac catheterization recovery room.

OBJECTIVE: To solve a capacity problem in a pediatric cardiovascular program, a 5- bed short-stay unit was created in the cardiac catheterization recovery room area within a 6-week timeframe. We describe the problem, solution, and early results in hospital performance and patient outcomes. METHODS: Data were reviewed for 183 patients who underwent various cardiac catheterization procedures and recovered overnight in the cardiac short-stay unit during the first 4 months of operation. The effect on bed use throughout the cardiac program and impact on the usual recovery room operations were assessed. RESULTS: The cardiovascular inpatient bed shortage was relieved with the creation of a 5-bed short-stay unit, and no cardiac procedures were canceled because of lack of beds during the study period. CONCLUSION: There was no negative impact on clinical operations in the catheterization laboratory recovery room, and the short-stay unit was cost-effective. According to the rate of admission after recovery in the short-stay unit (5/183), patient selection was appropriate.

A preliminary look at duplicate testing associated with lack of electronic health record interoperability for transferred patients.

Duplication of medical testing results in a financial burden to the healthcare system. Authors undertook a retrospective review of duplicate testing on patients receiving coordinated care across two institutions, each with its own electronic medical record system. In order to determine whether duplicate testing occurred and if such testing was clinically indicated, authors analyzed records of 85 patients transferred from one site to the other between January 1, 2006 and December 31, 2007. Duplication of testing (repeat within 12 hours) was found in 32% of the cases examined; 20% of cases had at least one duplicate test not clinically indicated. While previous studies document that inaccessibility of paper records leads to duplicate testing when patients are transferred between care facilities, the current study suggests that incomplete electronic record transfer among incompatible electronic medical record systems can also lead to potentially costly duplicate testing behaviors. The authors believe that interoperable systems with integrated decision support could assist in minimizing duplication of testing at time of patient transfers.