Biomedical subjects

Douglas Fish

Publications and source records attributed to Douglas Fish.

3 recordsLinked to original sources

PubMed2006

An assessment system for mapping CAPE outcomes in an advanced pharmacy practice experience program.

OBJECTIVE: To implement and evaluate an assessment system based on the 1998 Center for the Advancement of Pharmaceutical Education's (CAPE) Outcomes for students in advanced pharmacy practice experiences (APPEs). DESCRIPTION: The system requires each preceptor to create a summative assessment tool by choosing the most important 20-30 CAPE competencies and sub-elements necessary for his/her pharmacy practice with each to be scored by him/her on a 4-point scale from "exceeds expectations" to "below expectations." Students' grades are determined by an examination committee based on the preceptors' assessments. The system contains a mechanism to assist students with competency deficits and permits a student's yearlong performance in the APPE program to be considered when assigning grades for individual APPE courses. EVALUATION: The assessment system permits each student's performance in individual APPE courses to be mapped to the CAPE competencies for grading purposes. It permits class performance in an APPE program to be mapped to the CAPE competencies for quality assurance and school planning. CONCLUSION: An assessment system based on the 1998 CAPE Educational Outcomes competencies has been successfully introduced for students in APPE training.

Colorado↗

PubMed2006

Evidence that donor intrinsic response to G-CSF is the best predictor of acute graft-vs-host disease following allogeneic peripheral blood stem cell transplantation.

OBJECTIVE: Risk factors of acute graft-vs-host disease (GVHD) following allogeneic bone marrow transplantation have been well described before. In this study, we tested the hypothesis that acute GVHD after allogeneic peripheral blood stem cell (PBSC) transplant might be associated with donors' responsiveness to granulocyte colony-stimulating factor (G-CSF), rather than the dose of CD34(+) cells infused. PATIENTS AND METHODS: We retrospectively analyzed mobilization and transplant data (demographic characteristics, donor blood cell subsets after G-CSF, graft composition) in 149 consecutive HLA-identical donor/recipient pairs in order to identify acute GVHD risk factors. RESULTS: In 25% of donors, G-CSF mobilization led to an outstanding response, defined as greater than 117 x 10(6) CD34(+) cells/L. Overall, incidence of grades II-IV acute GVHD was 20.1% (95% CI: 16.6-23.6). Following univariate analysis, the incidence increased significantly in recipients receiving greater than 10 x 10(6) CD34(+) cells/kg (35% vs 15%; p = 0.007), and those transplanted from outstanding mobilizers (41% vs 12%, p < 0.0001). In multivariate analysis, only transplantation from outstanding mobilizers remained significant (p = 0.02). Donor or recipient demographic characteristics and lymphocyte subsets reinfused in the graft had no impact. CONCLUSIONS: We demonstrate for the first time that donor responsiveness to G-CSF is associated with acute GVHD following PBSC transplantation. If confirmed, this correlation will help to identify recipients who could potentially benefit from improved prophylaxis. As further corollary, decreasing the dose of CD34(+) cells infused is unlikely to prevent acute GVHD. Future studies should focus on the molecular bases of interindividual discrepancies in response to G-CSF.

Acute Disease↗

PubMed2004

Evaluation of different methods of leukoreduction of donor platelets to prevent alloimmune platelet refractoriness and induce tolerance in a canine transfusion model.

The effectiveness of different methods of leukoreduction in preventing alloimmune platelet refractoriness was evaluated in a canine model. Platelets from a random donor dog were administered for up to 8 weeks or until platelet refractoriness. Standard (STD; unmodified) platelets were accepted by 14% of recipients (n = 7) compared with 14% for centrifuge leukoreduced (C-LR) platelets (n = 21) and 31% for filter leukoreduced (F-LR) platelets (n = 13; no significant differences). Surprisingly, using both F-LR and C-LR platelets was highly effective (87% acceptance, n = 15). Transfusing F-LR/C-LR red blood cells (n = 4) or F-LR/C-LR plasma (n = 4), along with F-LR/C-LR platelets, did not affect platelet acceptance (100% acceptance). Overall acceptance of F-LR/C-LR platelets was 91% (n = 23; P < or = .05 versus STD, C-LR, or F-LR platelets). F-LR/C-LR transfusions also induced tolerance to subsequent STD platelet transfusions from the same donor (82% acceptance, n = 19) as well as to donor skin grafts without recipient immunosuppression (57% acceptance, n = 7). To evaluate mechanisms of tolerance induction, F-LR/C-LR platelets were gamma-irradiated. Although the gamma-irradiated F-LR/C-LR platelets were uniformly accepted (n = 6), tolerance to STD platelets was lost. These data suggest that some allostimulatory white cells are filter adherent, whereas others escape filtration but can be removed by centrifugation and tolerance requires a residual functioning white cell.

Animals↗