Intervention to improve adherence to ACC/AHA recommended adjunctive medications for the management of patients with an acute myocardial infarction.

BACKGROUND: The most recent published guidelines regarding management of patients surviving an acute myocardial infarction (AMI) advocate the administration of aspirin (ASA), beta blockers (BB), and angiotensin-converting enzyme inhibitors (ACEi) and discourages the use of calcium-channel blockers (CCB). Previous data collected in our region from the National Registry (NR) showed a dismal compliance with these guidelines. In an attempt to increase physician awareness and to optimize implementation of recommended guidelines, a cardiac and pharmacy steering committee was created. METHODS: The pharmacist assigned to the project identified all patients admitted with an AMI using troponin-I and creatine kinase-MB (CK-MB) reports. The pharmacist then contacted physicians to make recommendations if an adjunctive medication was not prescribed for a patient with no apparent contraindications. Administration rates for ASA, BB, ACEi, and CCB were then assessed and compared with the previously obtained baseline data from the NR. RESULTS: At admission, the use of ASA increased from 70 to 72%, BB from 45 to 72%, and ACEi from 12 to 44%. In terms of medications at discharge, ASA use increased from 74 to 88%, BB from 55 to 76%, and ACEi from 30 to 40%. In addition, the prescription rates for CCB at discharge decreased from 36 to 21%. CONCLUSIONS: An interdisciplinary approach for disease management is an effective method for improving adherence to treatment guidelines simply with pharmacy intervention. The percentage of patients receiving the recommended adjunctive medications increased significantly. We propose that these guidelines should be periodically inserviced to physicians. Furthermore, patient counseling sessions should also be instituted to help reinforce the importance of compliance with the medications after discharge, as well as lipid management and smoking cessation.

Characterization of a prolactin-inducible gene, clone 15, in T cells.

To examine how PRL regulates lymphocyte proliferation, a number of PRL-activated genes were identified from a PRL-dependent rat T lymphoma cell line, Nb2. One of the downstream genes in the PRL signaling cascade was identified as clone 15 (c15). PRL stimulation of quiescent Nb2 T cells results in the expression of a 1.7-kilobase c15 mRNA, which reaches maximum levels between 8 and 10 h after stimulation. Corresponding [3H]thymidine incorporation experiments show that the maximum level of c15 mRNA expression correlates with the G1/S transition phase of the cell cycle. Sequencing of approximately 1.3-kilobase cDNA revealed one open reading frame that predicts a 332-amino acid protein. In vitro transcription/translation of c15 cDNA resulted in the production of a 45-kilodalton protein. Sequence analysis revealed that the c15 open reading frame contains a potential nuclear localization signal, a very acidic region, and a carboxy-terminal region of 94 amino acids which are 68% identical and 78% similar to the nuclear movement protein, NUDC, found in Aspergillus nidulans. Such a high degree of conservation suggests that the NUDC-like motif in c15 has been conserved through evolution for an important structure and/or function.

Opioid antagonist effects on self-injury in adults with mental retardation: response form and location as determinants of medication effects.

The opioid antagonist naltrexone was administered to 8 adults with severe or profound mental retardation and extensive histories of self-injurious behavior. Five-minute behavioral samples were observed randomly out of every hour from 8 a.m. through 3 p.m., Monday through Friday, for four 2-week phases (baseline, placebo, 50 mg, and 100 mg). During naltrexone administration, there were fewer days with frequent head-banging and self-biting, whereas there were more days on which blows to the head or self-biting were infrequent. Self-injurious participants slept 1.38 hours less per night during baseline, which was unaffected by naltrexone.

A mutational hot spot in keratin 10 (KRT 10) in patients with epidermolytic hyperkeratosis.

Epidermolytic hyperkeratosis (EHK), (bullous congenital ichthyosiform erythroderma), is an autosomal dominant human skin disorder. Recently, we and others have described mutations in keratins 1 and 10 (K1 and K10) in patients with this disease. Structure-function models predict that these mutations would impair normal filament assembly and function. We have extended our earlier studies to include 8 more incidences of EHK. In half of these families, we were unable to locate a mutation within the rod domains of either K1 or K10. However, polymorphic restriction site and sequence analysis of the other families revealed a mutational hot spot within the 1A alpha-helical segment of K10. These involve Arginine to Histidine, Arginine to Cysteine and Arginine to Leucine substitutions at residue 10 of the rod domain. Interestingly, mutations in the corresponding Arginine residue in keratin K14 have been identified in patients with epidermolysis bullosa simplex. The large number of mutations found at this position in both keratins K10 and K14 suggests that other epithelia cell disorders will be discovered that are caused by the corresponding mutation in related type I keratin genes.

Human's choices in situations of time-based diminishing returns.

Three experiments examined adult humans' choices in situations with contrasting short-term and long-term consequences. Subjects were given repeated choices between two time-based schedules of points exchangeable for money: a fixed schedule and a progressive schedule that began at 0 s and increased by 5 s with each point delivered by that schedule. Under "reset" conditions, choosing the fixed schedule not only produced a point but it also reset the requirements of the progressive schedule to 0 s. In the first two experiments, reset conditions alternated with "no-reset" conditions, in which progressive-schedule requirements were independent of fixed-schedule choices. Experiment 1 entailed choices between a progressive-interval schedule and a fixed-interval schedule, the duration of which varied across conditions. Switching from the progressive- to the fixed-interval schedule was systematically related to fixed-interval size in 4 of 8 subjects, and in all subjects occurred consistently sooner in the progressive-schedule sequence under reset than under no-reset procedures. The latter result was replicated in a second experiment, in which choices between progressive- and fixed-interval schedules were compared with choices between progressive- and fixed-time schedules. In Experiment 3, switching patterns under reset conditions were unrelated to variations in intertrial interval. In none of the experiments did orderly choice patterns depend on verbal descriptions of the contingencies or on schedule-controlled response patterns in the presence of the chosen schedules. The overall pattern of results indicates control of choices by temporarily remote consequences, and is consistent with versions of optimality theory that address performance in situations of diminishing returns.