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PubMed1994

Three different types of dry eye syndrome.

We analyzed patients with dry eye syndrome with regard to autoimmune conditions. A total of 116 patients with dry eye syndrome were divided into three groups: simple dry eye (SDE), i.e., dry eye with no circulating autoantibodies; autoimmune positive dry eye (ADE), dry eye with circulating autoantibodies; and Sjogren's syndrome (SS), dry eye associated with Sjogren's syndrome. Schirmer test showed values of 3.0 +/- 2.2 mm in SDE, 3.1 +/- 2.0 mm in ADE, and 2.4 +/- 2.3 mm in SS reflecting the inadequacy of this test in differentiating among the groups. However, Schirmer test with nasal stimulation showed values of 19.1 +/- 12.4 mm in SDE and 16.4 +/- 10.9 mm in ADE, which were significantly higher than the 7.0 +/- 6.6 mm found in SS (p < 0.01). Moreover, ocular surface alterations evaluated by vital staining and brush cytology were significantly milder in SDE and ADE than in SS. SDE and ADE have less ocular surface abnormalities with good reflex tearing, whereas SS has less reflex tearing and more squamous metaplasia.

Adult↗

PubMed1993

Reperfusion with adenosine and nitroprusside improves preservation of isolated guinea pig hearts after 22 hours of cold perfusion with 2,3 butanedione monoxime.

The function of isolated guinea pig hearts treated with 2,3 butanedione monoxime (BDM) before, during, and initially after 22 h of hypothermic perfusion was examined during 4 h of normothermic reperfusion. BDM is a vasodilatory and negative inotropic agent that reversibly decreases sensitivity of contractile proteins to Ca2+. Also examined were the effects of adenosine (ADE) and nitroprusside (NP) in improving coronary flow (CF) and contractile function when given with BDM during rewarming and during the initial period of normothermic reperfusion. Isovolumetric left ventricular pressure (LVP), CF, and percentage of O2 extraction (%O2E) were measured in Krebs-Ringer-perfused hearts divided into three groups of 11 hearts each: drug-free controls (0 BDM); 10 mM BDM alone; and 10 mM BDM + 10 microM ADE + 100 microM NP. BDM was given 20 min before hypothermia, during hypothermia (3.8 degrees +/- 0.1 degree C) for 22 h, and for 30 min after rewarming to 37 degrees +/- 0.1 degree C; ADE was given with NP for only 20 min before and during rewarming and for 30 min after rewarming. Hearts were perfused at low constant flow with oxygenated Krebs' solution during hypothermia. After 2.5-h normothermic reperfusion, LVP (initial controls 108 +/- 6 mm Hg) increased more with BDM + ADE + NP (80 +/- 4% of control) than with BDM alone (62 +/- 3%) or without BDM (28 +/- 5%). CF (controls 6.0 +/- 0.5 ml/g/min) decreased less with BDM + ADE + NP (77 +/- 4% of control) than with BDM alone (60 +/- 5%) or without BDM (53 +/- 6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗

PubMedDate not supplied

Nurse's role in tracking adverse drug events: the impact of provider order entry.

Adverse drug events (ADE), or injuries caused by drug therapy, are a frequent and serious problem in hospitalized patients. Monitoring, preventing, and treating ADEs is an important patient safety function. Nurses play a significant role in this function, because their data is a unique and important indicator of ADEs and because they are the final point of medication administration. New provider order entry systems with electronic medical records have been viewed as an effective innovation and solution to high rates of ADEs. These systems increase legibility of drug orders, provide decision support, and increase access to the medical record. However, they may not interface with nursing processes effectively. This study reports the experience of a team conducting an ADE surveillance study in a Veterans Health Administration setting where extensive computerized innovations are in place. Lessons learned regarding the integration of nursing work processes with the computerized setting are described. Three areas of concern are highlighted: decreased access to nursing narratives, lack of decision support for medication administration, and failure to code nursing data. Each of these is discussed in terms of relevance to patient safety and the design of information systems.

Female↗

PubMed1998

Simultaneous high-performance liquid chromatography analysis of azithromycin and two of its metabolites in human tears and plasma.

This article describes a high-performance liquid chromatographic (HPLC) method for the measurement of azithromycin (AZI) and two of its metabolites, 9a-N-desmethylazithromycin (ADES) and N-desmethylazithromycin (NDES), in human tears and plasma. The drug, metabolites, and internal standard (n-propylazithromycin [IS]) were detected electrochemically after injection of the extracted sample into the HPLC system. The peak height ratio (AZI, ADES, or NDES to IS) varied linearly, with concentrations in the ranges of 0.1 mg/L to 2.0 mg/L (tears) and 0.01 mg/L to 2.0 mg/L (plasma) of AZI, ADES, and NDES; the correlation coefficient (r) was more than 0.994 mg/L for all of the compounds (n=6). The analysis of tear samples collected at different intervals within 12 hours to 144 hours after a dose of 20 mg/kg of AZI from a trachoma patient yielded concentrations ranging from 1.52 mg/L to 0.34 mg/L for AZI, 0.79 mg/L to 0.27 mg/L for ADES, and 1.99 mg/L to less than 0.20 mg/L for NDES. The concentration of AZI in plasma ranged from 0.15 mg/L to 0.01 mg/L, whereas ADES and NDES were undetectable.

Anti-Bacterial Agents↗

PubMedDate not supplied

Impact of cotherapy with some proton pump inhibitors on medical claims among HMO patients already using other common drugs also cleared by cytochrome P450.

Adverse drug event (ADE) rates resulting from coadministration of proton pump inhibitors (PPIs) and other drugs with potential for interaction with PPIs (DPIs) are unknown. This retrospective study assesses the occurrence of such ADEs and their potential impact on medical care costs by reviewing integrated medical and pharmacy claims. Managed care patients receiving one or more DPIs were identified. Within this sample, those who were also prescribed omeprazole or lansoprazole (DPI + PPI) were included. A second cohort (DPI alone) was created, matching for age, gender, and DPI use. Rates of ADEs were followed for 6 months after entry. Among PPI users, 58% used one or more DPIs, whereas 7% of DPI subjects used a PPI. Among claims arising from ADEs occurring in more than 1% of patients, 14 occurred in the DPI + PPI group and 2 occurred in the DPI-alone cohort, respectively, a highly significant difference. Crude odds ratios for the risks of specific ADEs were significantly increased for cotherapy with a PPI and warfarin, clarithromycin, corticosteroids, carbamazepine, nifedipine, or diclofenac. After adjustment, the first three associations remained significant. Coprescription of a PPI with potentially interacting drugs was common in practice and associated with significantly increased claims for medical care.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed2004

Effects of long-term episodic access to ethanol on the expression of an alcohol deprivation effect in low alcohol-consuming rats.

BACKGROUND: The alcohol-preferring (P) and -nonpreferring (NP) and high alcohol-drinking (HAD) and low alcohol-drinking (LAD) rats have been selectively bred for divergent preference for ethanol over water. In addition, both P and HAD rats display an alcohol deprivation effect (ADE). This study was undertaken to test whether the NP, LAD-1, and LAD-2 lines of rats could display an ADE as well. METHOD: Adult female NP, LAD-1, and LAD-2 rats were given concurrent access to multiple concentrations of ethanol [5, 10, 15% (v/v)] and water in an ADE paradigm involving an initial 6 weeks of 24-hr access to ethanol, followed by four cycles of 2 weeks of deprivation from and 2 weeks of re-exposure to ethanol (5, 10, and 15%). A control group had continuous access to the ethanol concentrations (5, 10, and 15%) and water through the end of the fourth re-exposure period. RESULTS: For NP rats, a preference for the highest ethanol concentration (15%) was evident by the end of the fifth week of access (approximately 60% of total ethanol fluid intake). Contrarily, LAD rats did not display a marked preference for any one concentration of ethanol. All three lines displayed an ADE after repeated cycles of re-exposure to ethanol, with the general ranking of intake being LAD-1 > NP > LAD-2 (e.g., for the first day of reinstatement of the third re-exposure cycle, intakes were 6.5, 2.9, and 2.4 g/kg/day compared with baseline values of 3.1, 2.0, and 1.3 g/kg/day for each line, respectively). By the 13th week, rats from all three lines, with a ranking of LAD-1 > NP > LAD-2, were drinking more ethanol (3.3, 2.2, and 2.0 g/kg/day, respectively) compared with their consumption during the first week of access (approximately 1.1 g/kg/day for all three lines). CONCLUSION: These data indicate that access to multiple concentrations of ethanol and exposure to multiple deprivation cycles can partially overcome a genetic predisposition of NP, LAD-1, and LAD-2 rats for low alcohol consumption. In addition, the findings suggest that genetic control of low alcohol consumption in rats is not associated with the inability to display an ADE.

Alcohol Drinking↗

PubMed1978

Distribution of incorporated, synthetic cytokinins in ribosomal RNA preparations from tobacco callus.

The distribution of incorporated synthetic cytokinins (N(6)-[8-(14)C]benzyladenine ([8-(14)C]bzl(6)Ade) and N(6)[8-(14)C]furfuryladenine ([8-(14)C]fr(6)Ade) in ribosomal RNA prepared from tobacco callus (Nicotiana tabacum L. var. Wis. No. 38) grown in the presence of one of these for 25 or 26 days has been studied. The rRNA of tissue supplied with [8-(14)C]bzl(6)Ade or [8-(14)C]fr(6)Ade was fractionated by methylated albumin-Kieselguhr column chromatography and preparative gel electrophoresis, respectively. In each case about 80% of the incorporated cytokinin was recovered as the ribonucleoside [8-(14)C]bzl(6)A or [8-(14)C]fr(6)A in the rRNA peak after the fractionations. [8-(14)C]fr(6)A was found associated with both the 18S and 25S rRNA components in quantities roughly proportional to their 260 nm absorbance. This pattern of apparently nonspecific association was not affected by prior denaturation of the RNA with formamide.The distribution of [8-(14)C]fr(6)A moieties in mono- and oligonucleotides derived from combined treatment of [8-(14)C]fr(6)Ade-labeled rRNA with ribonuclease T(1) and pancreatic ribonuclease A was measured by fractionating the digest on a DEAE-cellulose column in the presence of 7 m urea and determining the [8-(14)C]fr(6)A content in each fraction. The [8-(14)C]fr(6)A content in the oligonucleotides varied from 46 to 210 mumol/mol of adenosine (A). The mol ratio of [8-(14)C]fr(6)A to A was three to four times greater for oligonucleotides containing uridine or cytidine ([A](n)Up or [A](n)Cp) than for those containing quanosine ([A](n)Gp).

Journal Article↗

PubMed2005

Quantization of accumulated diffused errors in error diffusion.

Due to its high image quality and moderate computational complexity, error diffusion is a popular halftoning algorithm for use with inkjet printers. However, error diffusion is an inherently serial algorithm that requires buffering a full row of accumulated diffused error (ADE) samples. For the best performance when the algorithm is implemented in hardware, the ADE data should be stored on the chip on which the error diffusion algorithm is implemented. However, this may result in an unacceptable hardware cost. In this paper, we examine the use of quantization of the ADE to reduce the amount of data that must be stored. We consider both uniform and nonuniform quantizers. For the nonuniform quantizers, we build on the concept of tone-dependency in error diffusion, by proposing several novel feature-dependent quantizers that yield improved image quality at a given bit rate, compared to memoryless quantizers. The optimal design of these quantizers is coupled with the design of the tone-dependent parameters associated with error diffusion. This is done via a combination of the classical Lloyd-Max algorithm and the training framework for tone-dependent error diffusion. Our results show that 4-bit uniform quantization of the ADE yields the same halftone quality as error diffusion without quantization of the ADE. At rates that vary from 2 to 3 bits per pixel, depending on the selectivity of the feature on which the quantizer depends, the feature-dependent quantizers achieve essentially the same quality as 4-bit uniform quantization.

Algorithms↗

PubMed2004

Risk factors for adverse drug events among older adults in the ambulatory setting.

OBJECTIVES: To gather information on patient-level factors associated with risk of adverse drug events (ADEs) that may allow focus of prevention efforts on patients at high risk. DESIGN: Nested case-control study. SETTING: Large multispecialty group practice in New England. PARTICIPANTS: All Medicare enrollees cared for by a multispecialty group practice during 1 year (N=30,397 person-years from July 1, 1999, through June 30, 2000). For each patient with an ADE, a control was randomly selected. MEASUREMENTS: Data were abstracted from medical records on age, sex, comorbidities, and medication use at the time of the event. RESULTS: ADEs were identified in 1,299 older adults. Independent risk factors included being female and aged 80 and older. There were dose-response associations with the Charlson Comorbidity Index and number of scheduled medications. Patients taking anticoagulants, antidepressants, antibiotics, cardiovascular drugs, diuretics, hormones, and corticosteroids were at increased risk. In the analysis of preventable ADEs, the dose-response relationship with comorbidity and number of medications remained. Patients taking nonopioid analgesics (predominantly nonsteroidal antiinflammatory drugs and acetaminophen), anticoagulants, diuretics, and anti-seizure medications were at increased risk. CONCLUSION: Prevention efforts to reduce ADEs should be targeted toward older adults with multiple medical conditions or taking multiple medications, nonopioid analgesics, anticoagulants, diuretics, and antiseizure medications.

Age Factors↗

PubMedDate not supplied

Influence of cholinergic blockade on the development of epinephrine-induced ventricular arrhythmias in halothane- and isoflurane-anesthetized dogs.

The arrhythmogenic effects of anesthetic drugs are assessed using the arrhythmogenic dose of epinephrine (ADE) model. The purpose of this study was to determine the influence of cholinergic blockade (CB) produced by glycopyrrolate (G) on ADE in 1.5 minimum alveolar concentration (MAC) halothane (H)- and isoflurane (I)-anesthetized dogs. Eight dogs (weighing between 12.5 and 21.5 kg) were randomly assigned to four treatment groups (H, HG, I, and IG) and each treatment was replicated three times. Anesthesia was induced and maintained with H (1.31%, end-tidal [ET]) or I (1.95%, ET) in oxygen. Ventilation was controlled (carbon dioxide [PCO2] 35 to 40 mmHg, ET). G was administered 10 minutes before ADE determination at a dose of 22 microgram/kg (11 microgram/kg, intravenous [IV] and 11 micrograms/kg, intramuscular [IM]). The ADE was determined by IV infusion of epinephrine at sequentially increasing rates of 1.0, 2.5, and 5.0 micrograms/kg/min; and defined as the total dose of epinephrine producing at least four ectopic ventricular contractions (EVCs) within 15 seconds during a 3-minute infusion and up to 1 minute after the end of the infusion. Total dose was calculated as the product of infusion rate and time to arrhythmia. Data were analyzed using a randomized complete block analysis of variance. When significant (P < .05) F values were found a least significant difference test was used to compare group means. Values are reported as means +/- standard error. The ADE (micrograms/kg) for H, HG, I, and IG were 1.53 +/- 0.08, 3.37 +/- 0.46, 1.61 +/- 0.21, and > 15.00, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

PubMed1998

Antibody-dependent enhancement of feline infectious peritonitis virus infection in feline alveolar macrophages and human monocyte cell line U937 by serum of cats experimentally or naturally infected with feline coronavirus.

Infection of the type II feline infectious peritonitis virus (FIPV) strain 79-1146 to primary feline alveolar macrophages and human monocyte cell line U937 was enhanced by the sera of cats experimentally infected with the 79-1146 strain, but not those of cats infected with KU-2 or UCD-1 strain of type I FIPV. The experiments using sera of cats with feline infectious peritonitis (FIP) and of cats naturally infected with feline coronavirus (FCoV) revealed that infection of the FIPV 79-1146 strain to the U937 cells was enhanced only by the sera of cats infected with type II FIPV or feline enteric coronavirus. The samples positive for antibody-dependent enhancement (ADE) activity had high neutralizing antibody titers against the FIPV 79-1146 strain and the samples negative for ADE activity had low neutralizing antibody titers. These findings support the previous results where a monoclonal antibody with neutralizing activity had high ADE activity, suggesting that there was a close relationship between the neutralization and enhancement sites. And then it is also suggested that ADE of infection is likely to be induced by re-infection with the same serotype of virus in type II FIPV infection. Furthermore, U937 cells are considered useful and can be substituted for the feline macrophages for determining ADE of FIPV-infection.

Animals↗

PubMed2006

Adverse drug event reporting in intensive care units: a survey of current practices.

BACKGROUND: With the incidence of adverse drug events (ADEs) and adverse drug reactions (ADRs) higher in the intensive care unit (ICU) than other areas of the hospital, it is suspected that ADE/ADR surveillance systems differ between ICU and non-ICU areas. However, there is a lack of information about ADE/ADR identification, reporting, and evaluation strategies in the ICU. Understanding the frequency with which institutions incorporate standardized operational ADE/ADR definitions, triggers, and evaluation tools in this population will facilitate benchmarking between hospitals. OBJECTIVE: To determine whether ADE/ADR identification, reporting, and evaluation strategies differ between ICU and non-ICU populations and to characterize ADE/ADR reporting strategies in the ICU. METHODS: A validated survey was mailed to pharmacy directors at 590 randomly selected hospitals in the US having at least one ICU. A reminder was sent one week after the surveys were mailed. Five weeks later, a second survey was mailed to hospitals that did not respond. RESULTS: The response rate was 22% (132/590); institutions were predominantly community (68.2%), with 199 or fewer (54.5%) operational beds and 19 or fewer (60.6%) ICU beds. ICU types included mixed medical/surgical (62.1%), medical (48.5%), surgical (31.8%), coronary (29.5%), neonatal (22.7%), and cardiothoracic (15.2%). Operational definitions for ADEs and ADRs varied little between ICU and non-ICU areas, as 92.4% of institutions used the same term for both settings. Triggers were used to identify ADE/ADRs hospital-wide (75%) and were usually the same between ICU and non-ICU areas (88.6%). ADE reporting was nearly always voluntary (94.7%), using paper reports (88.6%), phone calls (22.7%), e-mail (12.1%), Intranet (12.1%), Web-based/Internet (10.6%), or PDA (1.5%). Only 22% of hospitals tracked ICU-specific data. CONCLUSIONS: ADE identification, reporting, and evaluation strategies are similar between ICU and non-ICU areas. Few institutions currently track ICU-specific ADE/ADR data. The institution of ICU-specific ADE detection and prevention strategies may improve the safety of critically ill patients.

Adverse Drug Reaction Reporting Systems↗

PubMed2003

Detection of drug-related adverse events in hospitals.

Adverse drug events (ADEs) contribute significantly to patient morbidity and mortality as well as to cost for healthcare providers and society. Since only serious ADEs will result in hospitalisation, the evaluation of ADEs leading to hospitalisation reflects safety and appropriateness of ambulatory prescribing. ADEs occurring during hospitalisation may result from the special clinical situation of hospitalised patients; high degree of severity of diseases (e.g., renal failure, necessity of intensive care) and specific drugs administered only in hospitals. Moreover, the number of diagnostic and therapeutic procedures carried out daily puts the hospitalised patient at an extremely high risk for ADEs.

Adverse Drug Reaction Reporting Systems↗

PubMed2003

The effect of computerized physician order entry on medication errors and adverse drug events in pediatric inpatients.

OBJECTIVE: Computerized physician order entry (CPOE) has the potential to reduce patient injury resulting from medication errors. We assessed the impact of a CPOE system on medication errors and adverse drug events (ADEs) in pediatric inpatients. DESIGN: A retrospective cohort study. SETTING: Tertiary care pediatric hospital. PARTICIPANTS: Pediatric inpatients on 3 medical and 2 surgical wards. INTERVENTION: CPOE system implemented on 2 medical wards and compared with 1 medical and 2 surgical wards that continued to use hand written orders. OUTCOME MEASURES: Rate of medication error and ADEs before and after CPOE implementation. RESULTS: In 6 years, a total of 804 medication errors were identified with 18 ADEs, resulting in patient injury among 36 103 discharges and 179 183 patient days. The overall medication error rate (MER) was 4.49 per 1000 patient days. Before the introduction of CPOE, the MERs of the intervention versus control wards were indistinguishable (ratio = 0.93; 95% confidence interval [CI] = 0.76, 1.13). After the introduction of CPOE, the MER was 40% lower on the intervention than on the control wards (ratio = 0.60; 95% CI = 0.48, 0.74). On average, 490 patient days are required to see the benefit of one less medication error using CPOE. We did not demonstrate a similar effect of CPOE for ADEs (ratio of rate ratios = 1.30; 95% CI 0.47, 3.52). CONCLUSIONS: The introduction of a commercially available physician computer order entry system was associated with a significant decrease in the rate of medication errors but not ADEs in an inpatient pediatric population.

Child↗

PubMed2001

The safety and antiviral effect of protease inhibitors in children.

STUDY OBJECTIVE: To determine the safety and antiviral effect of protease inhibitors (PIs) over 36 months in pediatric patients infected with the human immunodeficiency virus (HIV). DESIGN: Observational study SETTING: Pediatric immunodeficiency clinic. PATIENTS: Twenty-one children. INTERVENTION: Demographics, dosage regimens, genotype data, viral RNA and CD4+ lymphocyte counts, adverse drug events (ADEs), laboratory tests, and compliance were evaluated over 3 years. Data were analyzed by chi2, repeated measures analysis of variance, and paired t tests. MEASUREMENTS AND MAIN RESULTS: Twenty-one pediatric patients (aged 3 mo-15 yrs) received PIs over the study period. Average daily doses were ritonavir 26 mg/kg in 12 patients, nelfinavir 94 mg/kg in 16, indinavir 49 mg/kg in 5, and saquinavir 43 mg/kg in 4. Five patients developed resistance to an existing PI. Overall compliance was 70%. Baseline HIV-1 RNA plasma concentrations were significantly higher than average follow-up concentrations during 3-36 months in patients taking ritonavir (p<0.001) and nelfinavir (p<0.001). Sample size was insufficient for indinavir or saquinavir. Sixty ADEs occurred, diarrhea being most common. Of patients with ADEs, 55% required increased monitoring and 43% treatment. Ritonavir was associated with the most ADEs (28), followed by nelfinavir (16), indinavir (11), and saquinavir (5). Significant increases between baseline and follow-up cholesterol levels were found with ritonavir (p=0.02) and nelfinavir (p=0.001), and for serum creatinine (p=0.02) and triglycerides (p=0.02) with ritonavir. Follow-up triglycerides were significantly higher than baseline for indinavir (p=0.003). CONCLUSION: Nelfinavir and ritonavir were effective in decreasing HIV-1 viral loads and improving CD4+ lymphocyte counts. Ritonavir was associated with more ADEs than other PIs. Changes in cholesterol, serum creatinine, and triglycerides were noted with some PIs.

Adolescent↗

PubMed2005

Hospitalwide adverse drug events before and after limiting weekly work hours of medical residents to 80.

PURPOSE: Adverse drug events (ADEs) at a hospital before and after the weekly work hours of medical residents were limited to 80 were studied. METHODS: The study population included all adults admitted to a 750-bed academic tertiary care hospital where resident physicians provide direct care under the supervision of faculty attending physicians. The six-month period after implementation of the 80-hour work limit (July 1 to December 31, 2003) was compared with the same six-month period one year before implementation (July 1 to December 31, 2002). RESULTS: There were no significant differences between study periods in any measured variables, including number of confirmed ADEs (194 before, 172 after), number of ADEs per 1000 patient days (1.3 before, 1.1 after), and number of preventable ADEs (21 before, 22 after). CONCLUSION: Hospitalwide ADEs remained constant despite limiting of resident physician weekly work hours to 80.

Adult↗

PubMed2006

Errors associated with applying decision support by suggesting default doses for aminoglycosides.

BACKGROUND: Medication errors, and the resultant adverse drug events (ADEs), are one of the main preventable causes of morbidity and mortality. Computerised physician order entry (CPOE) is reported to reduce the frequency of these errors. However, CPOE systems themselves may be associated with errors. The aim of this study was to investigate the effects of a CPOE system that displays an initial default dose for gentamycin and tobramycin administration on the frequency of medication errors and potential ADEs in patients with renal insufficiency. METHODS: Gentamycin and tobramycin prescriptions from the CPOE records of a Dutch tertiary adult intensive care unit were retrospectively compared with doses recommended by a locally developed guideline. The default dose for gentamycin and tobramycin in the CPOE system is 240 mg/day. A dose prescribing error was defined as an administered dose that exceeded the recommended dose by >10%. RESULTS: Three hundred and ninty two prescriptions, relating to 253 patients (of whom 184 had renal insufficiency), were analysed. There was a high frequency (58%, 227 of 392) of prescriptions that used the CPOE system's default dose of 240 mg/day. The dose was wrong in 73% (165) of these orders. Default orders for patients with renal insufficiency amounted to 52% (132 of 259). A total of 86% (113 of 132) of these resulted in potential ADEs compared with 53% (66 of 124) for the rest of orders (p < 0.0001). DISCUSSION: A markedly high frequency of prescriptions followed the default dose value and, in patients with renal insufficiency, there was a high frequency of doses exceeding the guideline recommendation (+10%), amounting to potential ADEs. CONCLUSION: Initial CPOE dose values for prescribing gentamycin and tobramycin, which are based on a fixed default value, form a source of potential ADEs for patients with renal insufficiency.

Adult↗

PubMed2001

ATP suppresses the K(+) current responses to FSH and adenosine in the follicular cells of Xenopus oocyte.

The application of either follicle-stimulating hormone (FSH) or adenosine (Ade) induces a K(+)-current response in the follicular cells surrounding a Xenopus oocyte under a voltage clamp. These K(+)-current responses are reported to be produced by an increase in intracellular cAMP. A previous application of ATP to the same cells markedly depressed the K(+)-current responses to FSH and Ade. Furthermore, a 2 min application of phorbol 12,13-dibutyrate (PDBu), an activator of protein kinase C (PKC), significantly depressed the K(+)-current responses to FSH and Ade, but it had no significant effect on the Cl(-)-current response to ATP. An application of either ATP or PDBu also depressed the K(+)-current response induced by intracellularly applied cAMP. In contrast to the effect of PDBu, the application of 1-octanol, an inhibitor of gap junction channel, significantly depressed both the Ade- and ATP-induced responses, indicating that the acting site of 1-octanol is different from that of PKC. The results suggest that the depressing effect of ATP on the FSH- and Ade-induced K(+)-current responses might be mediated by PKC activation and that the site of PKC action might be downstream of the cAMP production involved in the K(+) channel opening.

Action Potentials↗