Background: Glycoprotein (GP) IIb/IIIa antagonists are used routinely for the treatment of acute coronary syndrome and to prevent thromboses during percutaneous coronary interventions. It is not uncommon for patients who initially require a GP IIb/IIIa inhibitor to eventually receive a surgical intervention. Objective: To compare the difference in bleeding indices in patients who undergo coronary artery bypass grafting (CABG) after receiving either eptifibatide or abciximab. Methods: A retrospective chart review was completed on all adults who received abciximab or eptifibatide within 24 hours prior to undergoing CABG. Patients were excluded if they had received a dose of warfarin within 96 hours prior to the procedure or if they had an incomplete medical record, an off-pump procedure, a known hypercoagulable disorder, or hemophilia. A total of 54 patients were included and preoperative data, including doses of anticoagulant and antiplatelet agents, were recorded. Intraoperative and postoperative data collected for analysis included hemoglobin level, chest tube output, and the amount of blood products transfused for 24 hours postprocedure. Results: There was a statistically significant difference between the eptifibatide and abciximab groups in the amount of fresh frozen plasma (mean ± SD, 21 ± 31 vs 187 ± 125 mL, respectively; p < 0.05) and platelets (212 ± 81 vs 433 ± 118 mL, respectively; p < 0.01) transfused during the intraoperative period. However, when the total amount of blood products transfused intraoperatively (769 ± 243 vs 1395 ± 316 mL, respectively; p = 0.47) was evaluated, no significant difference was detected. Likewise, markers for bleeding that were collected during the 24-hour postoperative window (immediate and 24-h postoperative hemoglobin and total 24-h chest tube output) were not significantly different. Conclusions: Although there is an increased risk of bleeding when abciximab or eptifibatide is administered prior to CABG, no significant difference in the total amount of blood products used was detected between the 2 agents in this study.

Background: The potential for medication errors in a hospital setting has led to a change from daily order writing to scheduled dosing. It has also been hypothesized that scheduled dosing may decrease the pharmacists' workload in a community teaching hospital. Objective: To evaluate the impact that scheduled warfarin dosing would have on patient safety for a pharmacist-run anticoagulation service. Methods: Two methods for managing warfarin in a pharmacist-run anticoagulation service were compared. A retrospective chart review was conducted on a random sample of 80 inpatients who received warfarin either from January 2006 through December 2006 (control/ daily dosing group) or from January 2007 through March 2007 (scheduled dosing group). Patients not managed by pharmacists or with a target international normalized ratio (INR) range other than 2 to 3 were excluded. Results: A total of 35 patients met inclusion criteria; 20 patients were in the daily order (control) group and 15 were in the scheduled dosing group. A total of 7 doses were omitted in the daily dosing group, compared with none in the scheduled dosing group. Of the 7, 4 were omissions in administration and 3 were order omissions. In the control group, the dose was changed 47 times (36%) compared with 23 times (28%) in the scheduled dosing group. In the daily dosing group, 28 (22%) INRs were within the therapeutic range and 97 (78%) were in the nontherapeutic range. In the scheduled dosing group, 24 (25%) INRs were within the therapeutic range and 72 (75%) were in the nontherapeutic range. Conclusions: Scheduled dosing eliminated omission-type medication errors and was more efficient than daily dosing. The process change decreased pharmacist workload without having a negative impact on patient care.

Reproduction in whole or in part without permission is prohibited. The production of a beta-lactamase—a type of bacterial enzyme—is the most common mechanism of resistance to beta-lactam antibiotics among gram-negative bacteria. Extended-spectrum beta-lactamases (ESBLs) hydrolyze most penicillins, extended-spectrum cephalosporins, and aztreonam. Infections due to ESBL-producing organisms are associated with increased mortality. Once an ESBL is detected, appropriate treatment is important in order to ensure optimal patient outcomes. Infections caused by ESBLs are challenging to treat for various reasons, including difficulty in detecting ESBL-producing organisms as well as mixed data on how to best treat these infections. The increasing worldwide prevalence of infections caused by ESBL-producing organisms highlights the importance of antimicrobial-stewardship programs to promote appropriate use of antibiotics and lessen the risk of subsequent development of resistance.

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Opioid analgesics are commonly used to treat acute and chronic pain; in 2016 alone, more than 60 million patients had at least 1 prescription for opioid analgesics filled or refilled. Despite the ubiquitous use of these agents, the effectiveness of long-term use of opioids for chronic noncancer pain management is questionable, yet links among long-term use, addiction, and overdose deaths are well established. Because of overprescribing and misuse, an opioid epidemic has developed in the United States. The health and economic burdens of opioid abuse on individuals, their families, and society are substantial. Part 1 of this supplement will provide a background on the burden of pain and the impact of opioid abuse on individuals, their families, and society; the attempts to remedy this burden through prescription opioid use; and the eventual downward spiral into the current opioid epidemic, including an overview of opioid analgesics and opioid use disorder and the rise in opioid-related deaths.

No description available.

No description available.

Objective: To describe relationship between cord blood (representing fetal) myo-inositol concentrations and gestational age (GA) and to determine trends of blood concentrations in enterally and parenterally fed infants from birth to 70 days of age. Design/Methods: Samples were collected in 281 fed or unfed infants born in 2005 and 2006. Myo-inositol concentrations were displayed in scatter plots and analyzed with linear regression models of natural log-transformed values. Results: In 441 samples obtained from 281 infants, myo-inositol concentrations varied from nondetectable to 1494 μmol/L. Cord myo-inositol concentrations decreased an estimated 11.9% per week increase in GA. Postnatal myo-inositol concentrations decreased an estimated 14.3% per week increase in postmenstrual age (PMA) and were higher for enterally fed infants compared to unfed infants (51% increase for fed vs. unfed infants). Conclusions: Fetal myo-inositol concentrations decreased with increasing GA. Postnatal concentrations decreased with increasing PMA and were higher among enterally fed than unfed infants.

Includes bibliographical references / The SADC Treaty 1992 established the Southern African Development Community (SADC) with the purpose of building an integrated regional economic community. The approach taken is to conclude Protocols in each area of co-operation. In the areas of economic and trade liberalization, a Protocol on Trade entered into force in 2000. The purpose of the Protocol is to establish a free trade area (FTA). The SADC FTA was formally launched in August 2008, when twelve SADC Member States phased out their tariffs covering substantial all intra-SADC trade. Namibia has been part of the SADC FTA since its inception. This research study examines the SADC FTA and its importance to Namibia by assessing the extent to which the SADC FTA has maximized export opportunities for Namibia to the region. It also identifies existing constraints that Namibia's exporters have been experiencing in accessing the SADC market, and provides recommendations on how Namibia can further exploit market opportunities created by the SADC FTA.

This dissertation discusses research undertaken on the topic of whether private parties have locus standi to invoke international trade agreements through Namibian courts. The study investigates how effective domestic courts are in adjudicating on matters pertaining to international trade law in Namibia and within other jurisdictions such as regional economic communities. There are two main objectives for this dissertation. Firstly, the capacity of Namibian courts to adjudicate on matters involving international trade law will be assessed. Secondly, the domestic courts' provision of effective redress to private parties in the event of violations of international trade agreements by Member States (in the absence of regional tribunals that grant private parties legal standing alongside Member States) will be assessed. The research has revealed that since Namibia became independent in 1990, there has been very little research undertaken on the effectiveness of the Namibian courts in adjudicating on disputes relating to international trade law. Human rights matters, on the other hand, have come before local courts. These cases will be examined but the different nature of trade issues has to be recognized. This study has further revealed that although Namibia and other States in Southern Africa grant locus standi to private parties to invoke international trade agreements before domestic courts, the adjudication by domestic courts of such issues depends on the constitutional structure of the States involved. The study identified the advantages and disadvantages in allowing domestic courts to play an active role in matters of international trade law. In dealing with the challenges associated with domestic courts adjudicating on such matters, regional and global issues have to be taken into account. This type of jurisprudence is still in its infancy.