Platelet-Rich Plasma (PRP) in Breast Cancer Patients: An Application Analysis of 163 Sentinel Lymph Node Biopsies.

INTRODUCTION: Literature shows platelet-rich plasma (PRP) to improve overall outcomes in orthopedics, dermatology, ophthalmology, gynecology, and plastic surgery. Data on oncological patients is very limited. Only one publication is available on PRP in breast cancer patients. This work evaluated PRP in sentinel node biopsy procedures for breast cancer patients in terms of complication rates and oncological short-term follow-up. METHODS: The evaluated PRP was ACP®, i.e., autologous conditioned plasma by Arthrex®. Between 2015 and 2018, 163 patients were offered to receive an ACP®/PRP injection in their lymph node biopsy site. Recruitment resulted in an approximate one-to-one ratio for analysis. Endpoints were major (revision) and minor (seroma, hematoma, and infection) complications rates as well as distant metastases, local recurrence, and overall survival. Median follow-up was 30 months. RESULTS: Complication rates and oncological follow-up showed PRP to be applicable to use in a sentinel node biopsy scenario in breast cancer patients. There were 0 revisions in the ACP®/PRP group and 1.2% revisions in the control group (not significant). Oncological follow-up showed zero (0) distant metastases and local recurrences as well as a 100% 30-month overall survival. CONCLUSIONS: This is the first analysis of ACP®/PRP used in breast cancer patients in a sentinel node biopsy setting worldwide. PRP does not seem to increase rates of local recurrence within this 30-month follow-up time frame. Also, trend towards decreasing complication rates could be shown.

Dietary supplement survey of pharmacists: personal and professional practices.

OBJECTIVE: To survey pharmacists about personal/professional practices regarding dietary supplements, specifically personal use and recommendation patterns, reference usage, and desired computerized decision-support features. DESIGN: Anonymous, self-administered survey. SETTING/LOCATION: National pharmacy association meeting. SUBJECTS: Practicing pharmacists who answered questions about dietary supplements. OUTCOME MEASURES: Acceptability of specific references, desired features in computerized decision support, frequency of personal use, and recommendations to patients, family, or friends. RESULTS: Seventy (70) pharmacists completed the survey. A majority (52.9%) reported taking dietary supplements including echinacea, zinc, and chromium picolinate. Fewer than half of pharmacists stated they have recommended a dietary supplement to a patient. Pharmacists stated that the top information sources were: published clinical trials, allopathic health care providers, alternative medicine practitioners, and word of mouth. The Internet was an important source for recommendations although not for personal use. The most highly accepted (>70%) print references included The Review of Natural Products and the World Health Organization Monographs on Selected Herbal Products. More than 90% rates the ability to view reference citations and computerized alerts on drug-dietary supplement interactions "very important" or "important". Interest was high in accessing computerized monographs. CONCLUSIONS: Pharmacists are self-educating about dietary supplements. Among pharmacists surveyed, there was some consensus as to which references were acceptable. There is a demand for dietary supplements information to be included in pharmacy computer systems, specifically to check for interactions against the patient's.drug profile. Although practitioners in Western and alternative medicine, as well as journal articles, are preferred information sources, the Internet and word of mouth are also important sources. Personal use of dietary supplements correlated with a twofold increase in the likelihood that a pharmacist would recommend a dietary supplement to a patient.

A concept-based medication vocabulary: an essential requirement for pharmacy decision support.

The impact of adverse drug events (ADEs) on the cost and quality of health care today is indisputable. A significant portion of these events can be detected and prevented with computerized pharmacy decision support systems. Challenges to the successful implementation of decision support systems include availability and quality of patient data and the accessibility of drug information that can be integrated programmatically on a patient-specific basis. An additional related challenge is establishing the vocabulary (i.e., codes, terms, and meanings) to be used for the representation, exchange, and automation of drug information and clinical functions. A central argument of this article is that a concept-based medication vocabulary needs to be created in order to facilitate the development of pharmacy decision support. We address the medication vocabulary challenge by defining a specific concept-based model of drugs as the basis for a standardized medication terminology.

The need for a concept-based medication vocabulary as an enabling infrastructure in health informatics.

Users of drug information typically focus their attention at different levels of description in different situations, such as medication ordering or dispensing. Computer systems utilizing drug information to support such activities must accommodate these multiple perspectives. This paper presents an approach to conceptualizing drug descriptions at multiple levels and outlines key features of an underlying information model that can serve as the basis for a concept-oriented medication vocabulary. These features include dose forms, routes of administration, as well as links to multiple drug classification schemes and medical problems. Implementation, standards, and maintenance issues related to the model are also discussed.

The future of knowledge-based components in the electronic health record.

Traditional monolithic healthcare information systems (HIS) no longer meet the requirements of today's distributed enterprises and the rapidly changing healthcare environment. The ability of applications to communicate, interpret, and act intelligently upon complex healthcare information has assumed paramount importance. The future lies in the development of flexible component-based architectures that can operate seamlessly within the workflow of a healthcare environment. A key design goal is "graceful degradation," i.e., providing the best decision support possible within the context of available patient data. The First DataBank Drug Toolkit is used as a case study. Several technical challenges associated with building truly plug and play components are discussed.

Medication usage patterns in patients with human immunodeficiency virus infection: a comparison of patient-reported medication usage with medical chart review.

Patients infected with the human immunodeficiency virus (HIV) receive numerous medications from multiple providers. As a result, it is important that medication usage is properly documented in each patient's medical record. Lack of adequate documentation may confound a provider's assessment of drug efficacy, potentially leading to an increased incidence of drug interactions and adverse effects. The objective of this study was to determine if discrepancies exist between patient-reported medication usage and that documented in the medical record by healthcare providers. Data were obtained using structured telephone surveys and medical chart review. Study participants were recruited from the University of California, San Francisco Medical Center AIDS Clinic. Results obtained for 41 patients demonstrated discrepancies between patient-reported medication usage and that documented in the medical record ranging from 9 to 92 percent, depending on the class of drug. The largest differences were observed with the "as-needed" class of drugs: benzodiazepines (92 percent), morphine (60 percent), and codeine (56 percent). Differences were also noted for scheduled medications: ketoconazole (54 percent), clotrimazole (45 percent), acyclovir (38 percent), zidovudine (15 percent), and pentamidine (9 percent). These observed discrepancies reaffirm the need for accurate exchange of information between provider and patient to promote the most effective, rational, and safe drug therapy. Careful reviews of medication usage at each visit and use of pharmacy-based medication profiles are potential mechanisms to improve documentation of medication usage in HIV-infected patients.

The pharmacokinetics of teicoplanin in varying degrees of renal function.

The pharmacokinetics of teicoplanin, a new glycopeptide antibiotic with activity against aerobic gram-positive bacteria, were characterized after intravenous administration of a single 3 mg/kg dose in five healthy volunteers and six patients with various degrees of stable renal insufficiency. Serum and urine samples were collected during a 15-day period and drug concentrations were assayed microbiologically. The mean elimination half-life of teicoplanin was 162.6 +/- 69.8 hours in healthy volunteers and was prolonged with decreased renal function. The mean plasma and renal clearances of teicoplanin in healthy subjects were 11.4 +/- 1.5 ml/min and 10.0 +/- 1.0 ml/min, respectively. Both values decreased in patients with renal failure and correlated significantly with measured creatinine clearances (r2 = 0.938 and 0.884, respectively). A nomogram for dosage adjustment in patients with varying degrees of renal failure is presented.

Risk of exposure to HIV infection for clinical pharmacists.

The increased risk for exposure of clinical pharmacists to human immunodeficiency virus (HIV) is described, and their role in minimizing the risk to themselves and others is delineated. Increasingly, pharmacists are becoming involved in patient-care activities that place them at risk for HIV exposure. These activities include participation on cardiac resuscitation teams, monitoring concentrations of drugs in patient samples that they themselves may collect, administering intravenous drugs, and performing a wide variety of primary-care duties in such outpatient settings as anticoagulation, diabetes, and acquired immunodeficiency syndrome (AIDS)-oncology clinics. Pharmacists can protect themselves against HIV infection by following established infection control procedures; at the same time, they must exercise responsibility for the safety of their associates, of pharmacy technicians, students, and residents, and of other health-care workers. In many institutions this responsibility is shared with nurses. As educators, pharmacists must play a leading role in the dissemination of correct, up-to-date information about HIV infection, body substances precautions, and new product use and availability in both the hospital and the community. The expanded role of pharmacists places them at higher risk for HIV infection but also creates opportunities for them to exercise leadership in the fight against AIDS.