Reducing preventable medication safety events by recognizing renal risk.

UNLABELLED: Evidence suggests that medication safety may be improved through more accurate assessment of renal function and appropriate dosing of renally cleared medications. The purpose of this article is to describe patient renal risk groups, associated medication errors, and ways that nurses can improve renal assessment. METHODS: Medication safety data were collected through voluntary reporting, computerized triggers, pharmacist surveillance, and retrospective chart review. Data were analyzed across 3 renal risk groups. RESULTS: Findings indicated that regarding the detected medication errors, elderly women were more likely to have hidden renal risk and that prescribing errors involving a wrong dose occurred more often in patients with high and hidden renal risk. Antibiotic and diabetic medications were the primary drug categories involved in these medication errors. RECOMMENDATIONS: Results indicated that identification of patients with hidden renal risk can be improved by routinely assessing serum creatinine and estimated creatinine clearance levels during renal assessments. Clinical nurse specialists can use this evidence to promote safer nursing care of renal patients.

Functional [6]pericyclynes: synthesis through [14+4] and [8+10] cyclization strategies.

Critical analysis of possible strategies for the synthesis of novel carbo-benzene derivatives suggests several [(18-n)+n] routes for the preparation of hexaoxy[6]pericyclyne precursors. Beyond the previously attempted [9+9] symmetrical scheme (n=9), the a priori most selective strategies are those for which n=1, 4, 7, 10, 13, and 16. They involve a cyclizing double-propargylation of a C(18-n) omega-bis-terminal-skipped oligoyne containing (19-n)/3 triple bonds with a C(n) omega-dicarbonyl-skipped oligoyne containing (n-1)/3 triple bonds. To complement the previously used [11+7] strategy, the [14+4] and [8+10] strategies were thus explored. They proved to be efficient, affording seven novel hexaoxy[6]pericyclynes corresponding to six different substitution patterns. These compounds were obtained in 7-15 steps as mixtures of stereoisomers. Thus, by using dibenzoylacetylene as the C(4) electrophile, a [14+4] strategy allowed the synthesis of two hexaphenyl representatives with two or four free carbinol vertices. This approach also afforded tetraphenyl representatives in which the two remaining carbinoxy vertices were substituted with either two alkynyl or one 4-anisyl and one 4-pyridyl groups. By using the hexacarbonyldicobalt complex of butynedial as the C(4) electrophile, a [14+4] strategy also allowed the isolation of a tetraphenylhexaoxy[6]pericyclyne with two adjacent unsubstituted carbinol vertices. A regioisomer with two opposite unsubstituted carbinol vertices was obtained through an [8+10] strategy and its oxidation afforded the corresponding pericyclynedione. Several attempts at synthesizing diphenylhexaoxy[6]pericyclynes with four unsubstituted carbinoxy vertices are described. Only an [8+10] strategy allowed the generation of a fragile diphenylhexaoxy[6]pericyclyne with four adjacent unsubstituted carbinoxy vertices, which could be partly characterized. These results show that the synthesis of the nonsubstituted hexahydroxy[6]pericyclyne, the ring carbo-mer of [6]cyclitol, is a difficult challenge.

The eating and physical activity habits of inner-city adolescents.

INTRODUCTION: The purposes of this study were to (a) analyze the body mass index (BMI) percentile and eating and physical activity habits of adolescents, viewing them by sex, ethnicity, household type, and foreign-born or born in the United States, and (b) evaluate diet and activity analysis software for use by practitioners and adolescent clients. METHOD: A descriptive-correlational study of 74 adolescents from low-income households completed a 24-hour recall of their foods, drinks, and activities, which were analyzed using MyPyramidTracker software. Data were analyzed using parametric and nonparametric methods to test associations and conduct between-group comparisons. RESULTS: Girls, Hispanics, adolescents living with single-parent mothers, and those who were foreign born had the highest mean BMI percentiles and the least healthy eating and physical activity habits. BMI percentile fell as daily calorie expenditure rose. MyPyramidTracker software is suitable for use by adolescents and their family members. DISCUSSION: To contribute to the reversal of national trends of increasing overweight status among adolescents, practitioners can focus their teaching, counseling, and advocacy on adolescents in these groups.

Computerized provider order entry system field research: the impact of contextual factors on study implementation.

Attention to contextual factors is essential to the conduct of high quality informatics field research. This is particularly true when the research focus is on complex information technology innovations like computerized provider order entry (CPOE) systems. From a field research perspective, CPOE systems are considered an organizational intervention. They are designed, implemented and used within an organizational context that encompasses cultural, economic, social and physical aspects. It is essential that informatics researchers address contextual factors when assessing the impact of CPOE systems. Inclusion of organizational contextual factors in CPOE system field studies permits a more accurate evaluation of the true impact these systems have on medication practice processes and outcomes. The goals of this paper are to: (1) identify contextual factors that influenced implementation of a federally-funded field study undertaken to examine the impact of a community hospital CPOE system on medication error outcomes; and (2) describe how these contextual factors influenced study methodology and implementation.

Quantum chemistry-based interpretations on the lowest triplet state of luminescent lanthanides complexes. Part 1. Relation between the triplet state energy of hydroxamate complexes and their luminescence properties.

In this paper, we evaluate the potential use of theoretical calculations to obtain an energy scale of the lowest ligand-centred triplet excited state in luminescent terbium(III) complexes. In these complexes, non-radiative deactivation of the terbium emitting state via a back-energy transfer process (T1<--Tb(5D4)) is a common quenching process. Consequently the prediction of the energy gap between these two excited states should be useful for programming highly luminescent Tb(III) systems. We report on a strategy based upon experimental and theoretical investigations of the excited state properties of a series of four simple aromatic hydroxamate ligands coordinated to Tb(III) and Gd(III) ions. By using previously reported crystallographic data, the structural and energies properties of these systems were investigated in the ground and first excited triplet states at the density functional theory (DFT) level of calculations. Our theoretical results are consistent with a triplet excited state T1 which is localised on one ligand only and whose the energy level is independent of the lanthanide ion nature (Tb(III), Gd(III)). A good agreement between the calculated adiabatic transition energies and experimental data derived from emission spectra is obtained when a corrective term is considered. These satisfactory results are an indication that this type of modelling can lead to discriminate in terms of the position of the lowest ligand triplet energy level the best antenna among a family of chromophoric compounds. In addition this theoretical approach has provided indications that the difference between the adiabatic transition energies of all the investigated complexes can be mainly explained by metal-ligand electrostatic interactions. The influence of the number of antennae on the quantum yield and the luminescence lifetime is discussed.