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Biomedical subjects

E A Flynn

Publications and source records attributed to E A Flynn.

11 recordsLinked to original sources
PubMed1999

Impact of interruptions and distractions on dispensing errors in an ambulatory care pharmacy.

A possible association between interruptions and distractions and the occurrence of dispensing errors was investigated. Fourteen pharmacists and 10 technicians in an ambulatory care pharmacy at a general medical-surgical hospital were tested for distractibility by using the group embedded figures test (GEFT) as well as for visual acuity and hearing. They were videotaped as they filled prescriptions during a 23-day period in 1992. A study investigator compared each filled prescription with the physician's written order, noted details of deviations, verified with the pharmacist any errors that occurred, and asked the pharmacist to correct the error if necessary. Interruptions and distractions were detected and characterized by reviewing the videotapes. None of the study participants had significant hearing or visual impairment. There was a significant association between GEFT scores and error rates. A total of 5072 prescriptions were analyzed, and 164 errors were detected, for an overall error rate of 3.23%. Wrong label information was the most common type of error (80% of errors detected). A total of 2022 interruptions (mean +/- S.D. per half hour per subject, 2.99 +/- 2.70) and 2457 distractions (mean +/- S.D. per half hour per subject, 3.80 +/-3.17) were detected. The error rate for sets of prescriptions with one or more interruptions was 6.65% and for sets during which there were one or more distractions, 6.55%. Interruptions and distractions per half hour were both significantly associated with errors. In an ambulatory care pharmacy, interruptions and distractions over a half-hour period were associated with dispensing errors, a majority of which involved incorrect label information.

Ambulatory Care Facilities↗
PubMed1999

Primary angiosarcoma of the ovary: a case report and review of the literature.

INTRODUCTION: Gynecological sarcomas are rare and have a poor prognosis. Uterine sarcomas are most common accounting for 4% of all uterine tumors. Ovarian sarcomas are less frequent and are usually carcinosarcomas. CASE REPORT: A previously healthy 40-year-old G2P2 presented for evaluation of 72 h of right upper quadrant pain and shortness of breath. A malignant right pleural effusion, ascites, and adnexal mass were found. Surgical staging and suboptimal debulking revealed pure angiosarcoma of the ovary Stage IV. DISCUSSION: There are 12 cases of ovarian angiosarcoma reported in the literature. Ten of these cases presented in advanced stages with survivals of 2-30 months. Various chemotherapy regimens have been tried on these tumors including the most recent recommendation of MAID (mesna, doxorubicin, ifosfamide, and dacarbazine) and prognosis remains poor. Our patient underwent elective right pleurodesis via video-assisted thorascopic surgery under local anesthesia for an early recurrent right pleural effusion and subsequently began MAID chemotherapy.

Adult↗
PubMed1998

Papillary and follicular thyroid carcinoma metastatic to the skin: a case report and review of the literature.

Cutaneous metastases from thyroid cancers are rare. We report the case of an otherwise asymptomatic 81-year-old woman with an enlarging scalp lesion. Her solitary skin metastasis was the presenting feature of thyroid carcinoma. Routine histopathology of the lesion was notable for an atypical clear cell neoplasm. Immunohistochemistry was positive for thyroglobulin. Subsequent resection of the thyroid gland identified separate foci (< 1 cm) for both papillary and follicular carcinoma. Although such immunohistochemical staining has been used previously, it has never been reported to provide the definitive diagnosis for a solitary cutaneous metastasis from the thyroid. Previous tumors had anatomic features in a clinical context that permitted identification by routine light microscopy. Clear cell features found in the follicular focus of carcinoma in the thyroid suggest that it is the primary. A worldwide literature review reveals that follicular carcinoma has a greater preponderance than papillary carcinoma for cutaneous metastasis and that the majority of skin metastases from either papillary or follicular thyroid cancer are localized to the head and neck.

Adult↗
PubMed1997

Observational study of accuracy in compounding i.v. admixtures at five hospitals.

Rates of errors in i.v. admixture compounding at five U.S. hospital pharmacies were studied. Pharmacy staff members at five hospitals representing each U.S. geographic region were observed as they compounded sterile products in order to record the medication, dose, base solution, and other details. Intravenous admixtures, antineoplastic preparations, parenteral nutrient solutions, and ready-to-use products were included. Observations took place for five days at each pharmacy. The observers' notes were checked against the labels used to prepare the doses; any deviation was considered an error. The clinical importance of each error was assessed for its potential to affect a patient adversely. The mean error rate for the five hospitals combined was 9% (145 errors for 1679 doses), excluding ready-to-use products. Mean error rates for individual pharmacies ranged from 6% to 10%. Wrong-dose errors were the most common type of error. Parenteral nutrient solutions had the highest error rates-37% for manual preparation and 22% for preparation that was partly automated. Of every 100 errors, 2 were judged to be potentially clinically important. In five U.S. hospital pharmacies, the observed error rate for compounding i.v. admixtures was 9%.

Data Collection↗
PubMed1996

Re-engineering a pharmacy work system and layout to facilitate patient counseling.

The development and evaluation of a new work system and facility design for a chain of community pharmacies are described. A new work system was developed to optimize utilization of pharmacist and technician time and allow the pharmacy to increase patient counseling without adding personnel. In the new system, pharmacists would review prescriptions, check technicians' work, and dispense prescriptions, counseling patients as needed; technicians would enter prescriptions into the pharmacy computer and fill them. The existing work system and design were evaluated in June and July of 1992 by observing, classifying, and recording activities of pharmacy personnel three days per week at six pharmacies in the chain. Pharmacy designs that would work with the new work system were created by a university design class after consultation with representatives of the pharmacy chain and the university's college of pharmacy. The pharmacy chain selected one design, and a detailed floor plan and specifications were created. To test how the new design and system would work at each of the six test pharmacies, a computer simulation program was developed and verified by using the data collected on the existing pharmacy operations. Computer simulation showed that, with the new design and system, increasing patient counseling would increase patient waiting time slightly but would not require additional personnel. The layout and work system in a chain of community pharmacies were redesigned to facilitate patient counseling and make the best use of employee time.

Community Pharmacy Services↗
PubMed1996

Relationships between ambient sounds and the accuracy of pharmacists' prescription-filling performance.

Associations between ambient sounds and accuracy of pharmacists' prescription-filling performance in a pharmacy was studied. Pharmacists were videotaped as they filled prescriptions each workday for 23 days. Each filled prescription was inspected by the investigator. Deviations from the physician's written order were considered errors. Videotape analysis was used to detect unpredictable, predictable, uncontrollable, and controllable sounds. A within-subjects case control study design was employed to determine whether the frequency of ambient sounds was significantly different when prescriptions with errors, compared with those without errors, were filled. Loudness, in terms of equivalent sound levels (Leq) for each half hour, was analyzed for a relationship to dispensing error rate. A mean dispensing error rate of 3.23% was found. Unpredictable sounds, controllable sounds, and noise had a significant effect on pharmacists which resulted in a decreased dispensing error rate. These results suggest that the quality of pharmacists' performance is not adversely affected by ambient sound. As equivalent sound levels increased, the error rate increased to a point, then decreased.

Case-Control Studies↗
PubMed1991

Sequential mast cell infiltration and degranulation during experimental carcinogenesis.

Mast cell density, distribution, and ultrastructure were studied by light and electron microscopy in hamster buccal pouches undergoing chemically induced carcinogenesis. Epidermoid carcinomas in the pouches were induced by three topical applications per week of 0.5% 7,12-dimethylbenz[a]anthracene (DMBA) in oil using a brush. Four experimental, DMBA-treated and two normal, untreated hamsters were sacrificed after 8, 10, 12, 14, and 16 weeks. After 8 weeks of DMBA treatment, the epithelium showed the pathological signs of dysplasia and hyperkeratosis. In the dermis an increased number of mast cells were evident, some of which showed degranulation. A few mast cells had started to migrate upwards towards the dysplastic epithelium after 10 weeks of DMBA treatment. Rapid degranulation was also apparent in some mast cells. These processes of upward migration and degranulation continued progressively during the 12- and 14-week periods of DMBA application in correlation with the progression of the tumor. By 16 weeks of treatment with the carcinogen, more mast cells had migrated closer to the invasive carcinoma, and many had degranulated. In the connective tissue mast cells were fully packed with many granules, and some mast cells were in proximity to macrophages and eosinophils. Our observations demonstrate that there is a positive correlation between developing carcinomas and mast cell density. Mast cell migration towards the carcinoma and degranulation were also evident.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1983

Autophagocytosis of melanosomes in cultured embryonic retinal pigment cells.

Autophagocytosis not only accounts for the early pigment loss found in proliferating cultured retinal pigment cells, but also occurs in slowly growing and in non-proliferating cells. Both melanosome synthesis and destruction may take place concurrently in cells. Autophagosomes may contain both fully formed melanosomes and also premelanosomes in various stages of formation, are positive for lysosomal enzyme activity, and likely represent secondary lysosomes.

Animals↗
PubMed1983

Effect of estradiol on ultrastructure of granular ducts in submandibular glands of female rats.

The effects of estradiol on the granular ducts in submandibular glands of female albino rats were studied. Twenty-five-milligram pellets of 17 beta-estradiol were implanted subcutaneously in the experimental animals, and their glands, as well as controls, were examined after 2, 4, 7, and 10 wk using light and electron microscopy. During the course of the experiment an increasing proportion of the granules in the granular ducts appeared more lightly stained in the experimental animals. In the estradiol-treated rats the granular ducts increased in relative cross-sectional area at a faster rate than in the controls, which exhibited maturation changes. In addition, the average number of granules per granular duct cell decreased significantly in the treated animals. Our results indicate that estradiol caused a change in the cytology of the granular ducts suggesting an alteration in protein synthesis. These results might occur through a change in structural proteins or in other hormones and growth factors which are known to influence the submandibular gland.

Animals↗
PubMed1979

Ultrastructure of normals and castrates and the effects of testosterone and ultraviolet (UVL-B) irradiation on scrotal skin of rats.

The ultrastructure of the testosterone dependent epidermal melanocyte system of the scrotal skin of normals and castrates, with and without testosterone replacement therapy, and UVL-B (280-315 nm) radiation in black Long Evans rats is reported. UVL-B increases melanocyte activity, melanosome forming apparatus, (size of Golgi zone and RER, and quantity of cytoplasmic vesicles, dendrites, and stages of melanosomes) in normals and in castrates. Testosterone replacement therapy to castrates is not a prerequisite for stimulation by UVL-B, but it enhances the effects of UVL-B without restoring normalcy as melanosome packaging into complexes predominates. After UVL-B stimulation of normals or castrates, melanocyte dendrites are observed more often. Melanocyte dendrites of skin of castrated rats are observed less often than in normals, but with testosterone replacement therapy, the dendrites become more numerous. Melanosomes donated to keratinocytes are mostly located as singles in normals and as complexes in castrates. After UVL-B, castration, or testosterone replacement therapy, the melanosomes are packaged in keratinocytes in complexes larger than in normals. In the epidermis of long term castrates (9-109 days), non-specific clear cells are observed and Langerhans cells containing melanosomes; we did not observe them in normals. Melanocytes of castrates have a reduced melanosome forming apparatus. The dermis of castrates contains many dermal melanocytes in the superficial dermis with melanosomes in several stages of formation. These cells are not apparent in normals at this location in the dermis. Testosterone replacement therapy and/or UVL-B administered to castrates does not restore the epidermal melanocyte system nor the dermis to precastration ultrastructural appearance; castration has a permanent altering effect as melanosomes are packaged into complexes.

Animals↗