Recommendations for the standardisation of oxytocin nasal administration and guidelines for its reporting in human research.

A series of studies have reported on the salubrious effects of oxytocin nasal spray on social cognition and behavior in humans, across physiology (e.g., eye gaze, heart rate variability), social cognition (e.g., attention, memory, and appraisal), and behavior (e.g., trust, generosity). Findings suggest the potential of oxytocin nasal spray as a treatment for various psychopathologies, including autism and schizophrenia. There are, however, increasing reports of variability of response to oxytocin nasal spray between experiments and individuals. In this review, we provide a summary of factors that influence transmucosal nasal drug delivery, deposition, and their impact on bioavailability. These include variations in anatomy and resultant airflow dynamic, vascularisation, status of blood vessels, mode of spray application, gallenic formulation (including presence of uptake enhancers, control release formulation), and amount and method of administration. These key variables are generally poorly described and controlled in scientific reports, in spite of their potential to alter the course of treatment outcome studies. Based on this review, it should be of no surprise that differences emerge across individuals and experiments when nasal drug delivery methods are employed. We present recommendations for researchers to use when developing and administering the spray, and guidelines for reporting on peptide nasal spray studies in humans. We hope that these recommendations assist in establishing a scientific standard that can improve the rigor and subsequent reliability of reported effects of oxytocin nasal spray in humans.

Creating a process to standardize regimen order sets within an electronic health record.

PURPOSE: US Oncology uses regimen order sets in clinical practice to treat patients. However, the process to assure accuracy and upkeep of these order sets has not been described. The purpose of this project was to evaluate the regimens housed in the electronic health record, iKnowMed, to determine their appropriateness and accuracy. MATERIALS AND METHODS: US Oncology conducted an audit of its standardized regimen library. A utilization review compared chemotherapy regimens in the library and consolidated order sets on the basis of past utilization. Next, internal and external clinical pharmacists were contracted to verify the accuracy, dose, duration, and cycle length of regimens. References cited in the regimen library were evaluated. New or updated references or clinical practice standards were added or modified when necessary. US Oncology corporate pharmacists reviewed the recommendations and discussed findings with an oversight committee. Final proposals were voted on before being incorporated into iKnowMed. An internal database tracking system tool for all reviewed recommendations was created to track and communicate needed changes to the electronic health record. RESULTS: Out of 511 regimen order sets, 51 were recommended for removal or consolidation. Of the remaining 460 regimen order sets, all had some administrative changes. Specifically, 75% had title changes, 14% had cycle-related changes, 31% had reference updates, and 13% had dosing updates. CONCLUSION: Electronic health records systems, such as iKnowMed, can provide standardized order sets for a large oncology network. However, the regimens need to be evaluated routinely using standardized procedures to ensure they are accurate and current.

Improving outpatient warfarin use for hospitalized patients with atrial fibrillation

Atrial fibrillation affects an estimated 5 million Americans and accounts for approximately 15% of all strokes. Few studies have successfully addressed patient screening, assessment, and introduction of appropriate antithrombotic therapy in patients with atrial fibrillation. Objective: To assess whether an intervention improved planned antithrombotic prescribing at the time of discharge in hospitalized patients. Methods: The study was a prospectively designed, retrospectively evaluated, non-blinded, historical control study of a pharmacist-initiated intervention. The intervention, consisting of pharmacist review and assessment of antithrombotic prescribing in patients with non-valvular atrial fibrillation, was conducted in an urban teaching hospital. Results: Although antithrombotic prescribing was not significantly higher at discharge in the 252 enrolled subjects (control 67.3% vs. intervention 70.8%; p = 0.58), a significantly greater number of patients had a written discharge plan for antithrombotic therapy (control 73.5% vs. intervention 88.3%; p < 0.01). The adjusted odds ratio that the study group was associated with an improvement in planned or actual warfarin use was 2.46 (95% CI 1.63-3.74). In addition, clinicians adhered to guidelines for antithrombotic therapy in patients with atrial fibrillation more frequently in the intervention group (control 70.4% vs. intervention 88.2%; p < 0.01). Conclusion: A program designed to identify hospitalized patients with non-valvular atrial fibrillation, assess their need for stroke prophylaxis, and initiate appropriate antithrombotic therapy led to an increase in planned antithrombotic, and most importantly, warfarin use upon discharge from the hospital. Confirmation that an increase in planned antithrombotic use upon discharge results in an actual increase in use after discharge is needed to determine the true effectiveness of this intervention (AU)

La fibrilación auricular afecta aproximadamente a 5 millones de norteamericanos y aparece en el aproximadamente el 15% de todos los infartos. Pocos estudios han afrontado con éxito el cribado de pacientes, la evaluación y la introducción de tratamiento antitrombótico apropiado en pacientes con fibrilación auricular. Objetivo: Evaluar si una intervención mejoraba la prescripción antitrombótica planeada en el alta en pacientes hospitalizados. Métodos: El estudio fue diseñado prospectivamente y evaluado retrospectivamente, no ciego, con control histórico de una intervención iniciada por el farmacéutico. La intervención, que consistía en la revisión y evaluación por un farmacéutico de la prescripción antitrómbótica de pacientes con fibrilación auricular no valvular, se llevó a cabo en un hospital universitario urbano. Resultados: Aunque la prescripción antitrombótica no fuie significativamente mayor en el alta en los 252 individuos (control 67.3% vs. intervención 70.8%; p = 0.58), un número significativamente mayor de pacientes tuvo un plan escrito al alta para el tratamiento antitrombótico (control 73.5% vs. intervención 88.3%; p < 0.01). El odds ratio ajustado de que el grupo de estudio estaba asociado a un mejor uso de la warfarina planificada o real fue 2,46 (CI95% 1.63-3.74). Además, los clínicos se adhirieron a las guías de tratamiento antitrombótico en pacientes con fibrilación auricular más frecuentemente en el grupo intervención (control 70.4% vs. intervención 88.2%; p < 0.01). Conclusión: Un programa diseñado para identificar pacientes hospitalizados con fibrilación auricular, evaluar su necesidad de prevención de infarto e iniciar tratamiento antitrombótico llevó a un aumento de antitrombóticos planificados, y más importante, al uso de warfarina al alta del hospital. Se necesita la confirmación de que un aumento en los antitrombóticos planificados lleve a un aumento en el uso real para determinar la verdadera efectividad de esta intervención (AU)

Improving outpatient warfarin use for hospitalized patients with atrial fibrillation.

UNLABELLED: Atrial fibrillation affects an estimated 5 million Americans and accounts for approximately 15% of all strokes. Few studies have successfully addressed patient screening, assessment, and introduction of appropriate antithrombotic therapy in patients with atrial fibrillation. OBJECTIVE: To assess whether an intervention improved planned antithrombotic prescribing at the time of discharge in hospitalized patients. METHODS: The study was a prospectively designed, retrospectively evaluated, non-blinded, historical control study of a pharmacist-initiated intervention. The intervention, consisting of pharmacist review and assessment of antithrombotic prescribing in patients with non-valvular atrial fibrillation, was conducted in an urban teaching hospital. RESULTS: Although antithrombotic prescribing was not significantly higher at discharge in the 252 enrolled subjects (control 67.3% vs. intervention 70.8%; p = 0.58), a significantly greater number of patients had a written discharge plan for antithrombotic therapy (control 73.5% vs. intervention 88.3%; p < 0.01). The adjusted odds ratio that the study group was associated with an improvement in planned or actual warfarin use was 2.46 (95% CI 1.63-3.74). In addition, clinicians adhered to guidelines for antithrombotic therapy in patients with atrial fibrillation more frequently in the intervention group (control 70.4% vs. intervention 88.2%; p < 0.01). CONCLUSION: A program designed to identify hospitalized patients with non-valvular atrial fibrillation, assess their need for stroke prophylaxis, and initiate appropriate antithrombotic therapy led to an increase in planned antithrombotic, and most importantly, warfarin use upon discharge from the hospital. Confirmation that an increase in planned antithrombotic use upon discharge results in an actual increase in use after discharge is needed to determine the true effectiveness of this intervention.