Alveolar bone healing accompanied by severe swelling in cleft children treated with bone morphogenetic protein-2 delivered by hydrogel.

BACKGROUND: The use of osteoinductive growth factors may be preferable for alveolar cleft repair because it eliminates the need of bone harvesting. In the present prospective randomised pilot study, patients with alveolar clefts were treated with either bone morphogenetic protein 2 (BMP-2) delivered by a hyaluronan-based hydrogel or autologous bone from the iliac crest. METHODS: Seven patients with cleft lip or cleft lip and palate were included. Computed tomography (CT) was performed preoperatively and 6 months postoperatively. The residual cleft volume was compared with the initial volume. Surgery time, bleeding and hospital stay were compared between the two groups. RESULTS: Four patients were randomised to treatment with BMP-2. A low BMP-2 concentration of 50 µg ml(-1) hydrogel did not induce bone formation in treated patients (n = 2) after 6 months, as seen by CT scans. Therefore, the BMP-2 concentration was raised to 250 µg ml(-1) hydrogel in the subsequently randomised patients (n = 2). Bone formation with volume ratio of 59% and 33% was here verified by CT scans after 6 months. However, a severe gingival swelling appeared during the first week in patients treated with higher BMP-2 doses. In the autologous bone group (n = 3), the volume ratio was 29%, 48%, and 69%. Mean surgery time was 100 min in the BMP-2 group and 123 min in the autologous bone group. The mean hospital stay was 2.75 and 3.33 days, respectively. CONCLUSIONS: BMP-2 at a concentration of 250 µg ml(-1) delivered by a hydrogel can be used to treat alveolar cleft defects with good bone quantity and comparable to autologous bone grafts. However, severe gingival swelling may limit the use of BMP-2 for these patients. Therefore, the study was prematurely closed.

Pharmacy continuing education--its value to hospital pharmacy practice.

A survey was mailed nationally to all hospitals with over 300 beds. A portion of the questionnaire focused on the academic training of current directors and their perceptions regarding continuing education. Less than 50 percent of the respondents perceived C.E. as being beneficial to them as a hospital pharmacy administrator. It is apparent from the survey results that there is a group of pharmacists who are not receiving the benefits desired from C.E. Recommendations are made that will increase the opportunities for management training for all pharmacists.

Legal status and organizational attitudes toward use of supportive personnel in pharmacy.

The status of supportive personnel in state pharmacy statutes and regulations and the attitudes toward supportive personnel of state pharmacy organizational representatives were studied. The board of pharmacy, pharmacy association, and hospital pharmacists' society of each state and the District of Columbia were surveyed by mail to determine legislative or regulatory control of supportive personnel and the attitudes towards the use of supportive personnel. Overall, 84% of the questionnaires were completed. In 21 states and the District of Columbia, nonpharmacist personnel were not mentioned in pharmacy laws or regulations. In the other 29 states, nonpharmacist personnel were allowed. Laws in 20 of these states specified ratios of technicians-to-pharmacists, usually 1:1. The term "supportive personnel" was most frequently used in these regulations. However, "pharmacy technician" was the term most frequently suggested as most appropriate by the respondents. Requirements for education and certification of supportive personnel are not common at this time. Hospital pharmacists' societies unanimously supported the use of technicians; slightly over half the boards of pharmacy and pharmacy associations did so. There is little uniformity currently in statutes or regulations concerning pharmacy supportive personnel.