Kwaku Marfo, Danielle Garcia, Saira Khalique, Karen Berger, Amy LuMontefiore Medical Center, Bronx, NY, USABackground: Medication errors are a prime concern for all in healthcare. As such the use of information technologies in drug prescribing and administration has received considerable attention in recent years, with the hope of improving patient safety. Because of the complexity of drug regimens in renal transplant patients, occurrence of medication errors is inevitable even with a well adopted computerized physician order entering system. Our objective was (...) to quantify medication error type and frequency in an inpatient renal transplant unit.Methods: Systemic evaluation of all medication errors during an initial 10-day audit and a 28-day follow-up audit in an inpatient renal transplant unit. Each error was concurrently evaluated for potential to result in adverse patient consequences, error type and associated medication class.Results: A total of 103 clinically significant medication errors were detected during the 10-day and 28-day audit time periods. The most common errors were wrong medication dose ordered and wrong time of drug administration. Thirty-six out of 66 prescribing/ordering errors reached the patient.Conclusions: Even with utilization of computerized physician order entry system in an inpatient renal transplant unit, post-kidney transplant patients are at risk for adverse outcomes due to medication errors. The risk factors may be multifactorial and will require both organizational and technical approaches to resolve.Keywords: medication errors, CPOE, inpatient, renal transplant patients. (shrink)

The near-interface region of an epitaxial Ba 0.3 Sr 0.7 TiO 3 thin film grown on LaAlO 3 was found to consist of a high density of stacking faults bounded by partial dislocations. The stacking faults can extend over large distances . Various possible atomic configurations of the faults were considered. The atomic structures of the faults were identified using high-resolution electron microscopy and simulation as well as energy-filtered imaging. The and faults were found to lie predominately on the {100} (...) and {110} planes. The faults on , or have never been observed before in perovskites. The stacking faults on {100} have a structure consisting of a double layer of edge-sharing TiO 6 octahedra. The excess of Ti was detected by energy-filtered imaging. The formation of the extended stacking faults is probably related to a small amount of excess Ti during the film deposition, which may originate from the non-stoichiometry of the ceramic targets BaTiO 3 and SrTiO 3 . It is also enhanced by the misfit-induced compressive strain in the early stages of the film growth. (shrink)

The aim of this article is to argue for the need for a context-sensitive approach to the understanding of ethical issues in nursing practice as we face the next millennium. This approach means that the idea of universalism must be questioned because ethics is an interpersonal activity, set in a specific context. This view is based on issues that arise in international collaborative research as well as in research focused on ethical problems in nursing practice. Moral values are indigenous to (...) a particular culture and influence beliefs about health and illness as well as what priorities are to be made in providing health care. Nursing practice must include thoughtful reflection on the meaning of moral concepts and principles in terms of culture. Theoretical developments in nursing ethics must be based on empirical research focusing on contextual aspects of health care. (shrink)

Over the past decades, anti-cancer treatments have evolved rapidly from cytotoxic chemotherapies to targeted therapies including oral targeted medications and injectable immunooncology and cell therapies. New anti-cancer medications come to markets at increasingly high prices, and health insurance coverage is crucial for patient access to these therapies. State laws are intended to facilitate insurance coverage of anti-cancer therapies.Using Massachusetts as a case study, we identified five current cancer coverage state laws and interviewed experts on their perceptions of the relevance of (...) the laws and how well they meet the current needs of cancer care given rapid changes in therapies. Interviewees emphasized that cancer therapies, as compared to many other therapeutic areas, are unique because insurance legislation targets their coverage. They identified the oral chemotherapy parity law as contributing to increasing treatment costs in commercial insurance. For commercial insurers, coverage mandates combined with the realities of new cancer medications — including high prices and often limited evidence of efficacy at approval — compound a difficult situation. Respondents recommended policy approaches to address this challenging coverage environment, including the implementation of closed formularies, the use of cost-effectiveness studies to guide coverage decisions, and the application of value-based pricing concepts. Given the evolution of cancer therapeutics, it may be time to evaluate the benefits and challenges of cancer coverage mandates. (shrink)

On Buddhist ethics for better conduct of life.

En este texto abordo una de las propuestas ontológicas, epistémicas y metodológicas que sintetiza mejor el trabajo de las epistemologías feministas sobre cómo conceptualizar las nociones de género y sexo, así como su relación en el ámbito biológico. Describo los alcances y limitaciones de esta propuesta y muestro que la propia noción de sexo implica un sesgo androcéntrico desde el que se legitima la dicotomía endógeno/exógeno, un reduccionismo funcional, la idea de coherencia interna y la reducción de nuestra complejidad biológica (...) a los rasgos vinculados con la reproducción respecto a las diferencias biológicas en general y, como mostraré, en el ámbito biomédico en particular al caracterizar las prevalencias y el desarrollo de enfermedades. En contraste, propongo la idea de epigenealogía para una reconceptualización histórica de nuestra materialidad biológica capaz de profundizar en cómo nuestra plasticidad a través de los procesos epigenéticos danza sincrónicamente con nuestra experiencia social, contingente y situada. (shrink)

Lower plasma levels of high-density lipoproteins in adolescents with type 2 diabetes have been associated with a higher pulse wave velocity, a marker of arterial stiffness. Evidence suggests that HDL proteins or particle subspecies are altered in T2D and these may drive these relationships. In this work, we set out to reveal any specific proteins and subspecies that are related to arterial stiffness in youth with T2D from proteomics data. Plasma and PWV measurements were previously acquired from lean and T2D (...) adolescents. Each plasma sample was separated into 18 fractions and evaluated by mass spectrometry. Then, we applied a validated network-based computational approach to reveal HDL subspecies associated with PWV. Among 68 detected phospholipid-associated proteins, we found that seven were negatively correlated with PWV, indicating that they may be atheroprotective. Conversely, nine proteins show positive correlation with PWV, suggesting that they may be related to arterial stiffness. Intriguingly, our results demonstrate that apoA-I and histidine-rich glycoprotein may reverse their protective roles and become antagonistic in the setting of T2D. Furthermore, we revealed two arterial stiffness-associated HDL subspecies, each of which contains multiple PWV-related proteins. Correlation and disease association analyses suggest that these HDL subspecies might link T2D to its cardiovascular-related complications. (shrink)