Quality practice. Maintaining specialized clinical competencies.

To better elucidate the ecological effects of naphthenic acids and major ions liberated in oil sands development, the summer-time composition of phytoplankton communities in ten water bodies near Fort McMurray (northeastern Alberta) was studied in 1997. The water bodies varied in degree of process water influence, and in age, size and ancillary chemical characteristics. Community biomass of phytoplankton was not systematically related to naphthenic acid or major ion concentrations, even though the higher naphthenate concentrations exceeded published EC50's for acute effects on several different aquatic species. Chlorophyta were frequently dominant, particularly where naphthenate and major ion concentrations were highest. Canonical Correspondence Analysis (CCA) revealed gradients in taxonomic composition at a finer (genus and species) taxonomic level. Despite the simultaneous and uncontrolled variation of other environmental factors, naphthenate and major ion concentrations (as indexed by conductivity) explained a highly-significant 40% of the variation in taxonomic composition. Systems with naphthenates <6.5 mg l(-1) and conductivity <800 PhiS cm(-1) were clustered together near the origin of the CCA plots, suggesting little ecological effect at such concentrations. Taxa associated with elevated naphthenate and/or major ion concentrations were derived from six different algal divisions and included many that were identified as tolerant in previous bioassay experiments. Over the range of concentrations encountered (1.5-45 and 100-3000 mg l(-1) for naphthenates and ions, respectively), CCA indicated that the ecological effect of major ions appeared to be at least as great as that of naphthenates.

Alberta↗

PubMed2002

Puzzling vitamin D results.

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Alberta↗

PubMed2002

A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP).

BACKGROUND: Despite clear evidence for the efficacy of lowering cholesterol levels, there is a deficiency in its real-world application. There is a need to explore alternative strategies to address this important public health problem. This study aimed to determine the effect of a program of community pharmacist intervention on the process of cholesterol risk management in patients at high risk for cardiovascular events. METHODS: A randomized controlled trial conducted in 54 community pharmacies (1998-2000) included patients at high risk for cardiovascular events (with atherosclerotic disease or diabetes mellitus with another risk factor). Patients randomized to pharmacist intervention received education and a brochure on risk factors, point-of-care cholesterol measurement, referral to their physician, and regular follow-up for 16 weeks. Pharmacists faxed a simple form to the primary care physician identifying risk factors and any suggestions. Usual care patients received the same brochure and general advice only, with minimal follow-up. The primary end point was a composite of performance of a fasting cholesterol panel by the physician or addition or increase in dose of cholesterol-lowering medication. RESULTS: The external monitoring committee recommended early study termination owing to benefit. Of the 675 patients enrolled, approximately 40% were women, and the average age was 64 years. The primary end point was reached in 57% of intervention patients vs 31% in usual care (odds ratio, 3.0; 95% confidence interval, 2.2-4.1; P<.001). CONCLUSIONS: A community-based intervention program improved the process of cholesterol management in high-risk patients. This program demonstrates the value of community pharmacists working in collaboration with patients and physicians.

Alberta↗