Warfarin toxicity: do discharge ICD-10 codes and yellow cards accurately identify serious adverse drug reactions?

Focal points: ICD-10 codings and spontaneous yellow card reports for warfarin toxicity were compared retrospectively over a one-year period Eighteen cases of ICD-10 coded warfarin toxicity were identified from a total of 55,811 coded episodes More than three times as many ADRs to warfarin were found by screening ICD-10 codes as were reported spontaneously using the yellow card scheme Valuable information is being lost to regulatory authorities and as recognised reporters to the yellow card scheme, pharmacists are well placed to report these ADRs, enhancing their role in the safe and appropriate prescribing of warfarin

Strategic HRM through the cultural looking glass:mapping the cognition of British and Indian managers

This study examines the issues of `integration' of human resource management (HRM) into the corporate strategy, `devolvement' of HRM to line managers and the perceived influence of national culture on HRM in a cross-national comparative context. In order to achieve this, the cognition of personnel specialists from a matched sample of 48 Indian and British firms in the manufacturing sector using the `Visual Cards Sorting' and `CMAP2' methodologies are analyzed. The findings show that even where there is an apparent convergence of strategy — e.g., the desire of both Indian and British personnel managers to increase integration between HRM and business strategy, and to increase the level of devolvement to line managers, the two sets of specialists clearly follow a different logic of action, which is subject to a different set of cross-cultural influences. The implications of pursuing apparently similar HRM solutions in different cross-national contexts are considered. The analysis shows that HRM strategies, when considered in a cross-national context, vary a lot. Different logic leads to the adoption of similar HR strategies, and similar strategies in turn are perceived as producing different outcomes. This variance centres around the existence and perceived influence of several contextual variables such as industrial relations systems, operation of labour markets, and changes in business systems. Specific cross-cultural influences, along with different aspects of competitive business environment associated with the generic HR strategies of integration and devolvement in the two countries are highlighted. This research contributes to the fields of cross-cultural management research, international HRM and managerial and organizational cognition. It also has important messages for policy makers.

Tetrahydrobiopterin metabolism in mental disorders

Changes in DHPR activity in those aged 12 and under with a variety of mental disorders were investigated using dried blood spots on Guthrie cards. DHPR activity was found to be lowered in autism and Rett's syndrome. DHPR activity was unaffected in non specific mental retardation suggesting that the deficit seen in autism and Rett's syndrome does not arise secondary to the mental dysfunction. In Down's syndrome blood biopterin levels correlated with blood spot DHPR activity. Human brain BH4 synthetic activity was investigated in aging and senile dementia of the Alzheimer type (SDAT). BH4 synthetic activity and DHPR activity decline with age in non-demented controls. In SDAT, decreases in BH4 synthetic activity were seen in temporal and visual cortices and locus coeruleus. The site of the defect is probably at 6-pyruvoyl-tetrahydropterin synthase. Aluminium inhibits human brain BH4 synthesis in vitro and produces an `Alzheimeresque' pattern of abnormalities in rats chronically exposed to the acetate salt in drinking water. Aluminium appears to chiefly affect enzymes requiring a metal ion cofactor. Aluminium induced inhibition of BH4 synthesis can be reversed by treatment with transferrin, an aluminium chelator. Transferrin treatment improves BH4 synthetic activity in SDAT brains whilst having no effect on controls, further implicating aluminium as the key neurotoxin in SDAT. Lithium inhibits human brain BH4 synthesis in vitro and lowers rat brain total biopterins and inhibits rat brain BH4 synthesis on chronic exposure to the carbonate salt in drinking water. A possible mechanism for the anti-manic actions of lithium is suggested. Monoamine oxidase inhibitors decrease human brain BH4 synthetic activity in vitro. 5-methyl-tetrahydrofolate had no effect on human brain BH4 synthesis in vitro but methionine increased BH4 synthesis in vitro. Oxotremorine is a potent inhibitor of BH4 synthesis in man and the rat. This may prove useful as a tool for modelling BH4 deficiency.

Asthma management : implementation of short-acting beta agonist guidelines in Western Australia:a unique collaboration

Background: The Respiratory Health Network in Western Australia developed the Asthma Model of Care in 2010 which incorporates best practice guidelines. At the same time short-acting beta agonist guidelines (SABA) were developed by stakeholder consensus at University of Western Australia (UWA) and incorporated the use of an Asthma Action Plan Card. Objective: To report on the implementation of a key component of the WA Asthma Model of Care, the SABA guidelines that incorporate the Asthma Action Plan card. Methods: Implementation strategies included lectures, direct pharmacy detailing, media releases, and information packs (postal and electronic). Groups targeted included pharmacists, consumers and medical practitioners. Results: State-based (n=18) and national (n=6) professional organisations were informed about the launch of the guidelines into practice in WA. In the four-month implementation period more than 47,000 Asthma Action Plan Cards were distributed, primarily to community pharmacies. More than 500 pharmacies were provided with information packs or individual detailing. More than 10,000 consumers were provided with information about the guidelines. Conclusions and implications: The collaboration of stakeholders in this project allowed for widespread access to various portals which, in turn, resulted in a multifaceted approach in disseminating information. Ongoing maintenance programs are required to sustain and build on the momentum of the implementation program and to ultimately address patient outcomes and practice change, which would be the longer-term goals of such a project. Future research will seek to ascertain the impact of the card on patient outcomes in WA.

Identification and analysis of moderator variables:investigating the customer satisfaction-loyalty link

Purpose – Research on the relationship between customer satisfaction and customer loyalty has advanced to a stage that requires a more thorough examination of moderator variables. Limited research shows how moderators influence the relationship between customer satisfaction and customer loyalty in a service context; this article aims to present empirical evidence of the conditions in which the satisfaction-loyalty relationship becomes stronger or weaker. Design/methodology/approach – Using a sample of more than 700 customers of DIY retailers and multi-group structural equation modelling, the authors examine moderating effects of several firm-related variables, variables that result from firm/employee-customer interactions and individual-level variables (i.e. loyalty cards, critical incidents, customer age, gender, income, expertise). Findings – The empirical results suggest that not all of the moderators considered influence the satisfaction-loyalty link. Specifically, critical incidents and income are important moderators of the relationship between customer satisfaction and customer loyalty. Practical implications – Several of the moderator variables considered in this study are manageable variables. Originality/value – This study should prove valuable to academic researchers as well as service and retailing managers. It systematically analyses the moderating effect of firm-related and individual-level variables on the relationship between customer satisfaction and loyalty. It shows the differential effect of different types of moderator variables on the satisfaction-loyalty link.

A novel dried blood spot-LCMS method for the quantification of methotrexate polyglutamates as a potential marker for methotrexate use in children

Objective: Development and validation of a selective and sensitive LCMS method for the determination of methotrexate polyglutamates in dried blood spots (DBS). Methods: DBS samples [spiked or patient samples] were prepared by applying blood to Guthrie cards which was then dried at room temperature. The method utilised 6-mm disks punched from the DBS samples (equivalent to approximately 12 μl of whole blood). The simple treatment procedure was based on protein precipitation using perchloric acid followed by solid phase extraction using MAX cartridges. The extracted sample was chromatographed using a reversed phase system involving an Atlantis T3-C18 column (3 μm, 2.1x150 mm) preceded by Atlantis guard column of matching chemistry. Analytes were subjected to LCMS analysis using positive electrospray ionization. Key Results: The method was linear over the range 5-400 nmol/L. The limits of detection and quantification were 1.6 and 5 nmol/L for individual polyglutamates and 1.5 and 4.5 nmol/L for total polyglutamates, respectively. The method has been applied successfully to the determination of DBS finger-prick samples from 47 paediatric patients and results confirmed with concentrations measured in matched RBC samples using conventional HPLC-UV technique. Conclusions and Clinical Relevance: The methodology has a potential for application in a range of clinical studies (e.g. pharmacokinetic evaluations or medication adherence assessment) since it is minimally invasive and easy to perform, potentially allowing parents to take blood samples at home. The feasibility of using DBS sampling can be of major value for future clinical trials or clinical care in paediatric rheumatology. © 2014 Hawwa et al.

A simple bioanalytical method for the quantification of antiepileptic drugs in dried blood spots

An increasing number of publications on the dried blood spot (DBS) sampling approach for the quantification of drugs and metabolites have been spurred on by the inherent advantages of this sampling technique. In the present research, a selective and sensitive high-performance liquid chromatography method for the concurrent determination of multiple antiepileptic drugs (AEDs) [levetiracetam (LVT), lamotrigine (LTG), phenobarbital (PHB)], carbamazepine (CBZ) and its active metabolite carbamazepine-10,11 epoxide (CBZE)] in a single DBS has been developed and validated. Whole blood was spotted onto Guthrie cards and dried. Using a standard punch (6 mm diameter), a circular disc was punched from the card and extracted with methanol: acetonitrile (3:1, v/v) containing hexobarbital (Internal Standard) and sonicated prior to evaporation. The extract was then dissolved in water and vortex mixed before undergoing solid phase extraction using HLB cartridges. Chromatographic separation of the AEDs was achieved using Waters XBridge™ C18 column with a gradient system. The developed method was linear over the concentration ranges studied with r ≥ 0.995 for all compounds. The lower limits of quantification (LLOQs) were 2, 1, 2, 0.5 and 1 μg/mL for LVT, LTG, PHB, CBZE and CBZ, respectively. Accuracy (%RE) and precision (%CV) values for within and between day were <20% at the LLOQs and <15% at all other concentrations tested. This method was successfully applied to the analysis of the AEDs in DBS samples taken from children with epilepsy for the assessment of their adherence to prescribed treatments.

The dark side of the internet:protecting yourself and your family from online criminals

In less than a decade, personal computers have become part of our daily lives. Many of us come into contact with computers every day, whether at work, school or home. As useful as the new technologies are, they also have a darker side. By making computers part of our daily lives, we run the risk of allowing thieves, swindlers, and all kinds of deviants directly into our homes. Armed with a personal computer, a modem and just a little knowledge, a thief can easily access confidential information, such as details of bank accounts and credit cards. This book helps people avoid harm at the hands of Internet criminals. It offers a tour of the more dangerous parts of the Internet, as the author explains who the predators are, their motivations, how they operate and how to protect against them. In less than a decade, personal computers have become part of our daily lives. Many of us come into contact with computers every day, whether at work, school or home. As useful as the new technologies are, they also have a darker side. By making computers part of our daily lives, we run the risk of allowing thieves, swindlers, and all kinds of deviants directly into our homes. Armed with a personal computer, a modem and just a little knowledge, a thief can easily access confidential information, such as details of bank accounts and credit cards. This book is intended to help people avoid harm at the hands of Internet criminals. It offers a tour of the more dangerous parts of the Internet, as the author explains who the predators are, their motivations, how they operate and how to protect against them. Behind the doors of our own homes, we assume we are safe from predators, con artists, and other criminals wishing us harm. But the proliferation of personal computers and the growth of the Internet have invited these unsavory types right into our family rooms. With a little psychological knowledge a con man can start to manipulate us in different ways. A terrorist can recruit new members and raise money over the Internet. Identity thieves can gather personal information and exploit it for criminal purposes. Spammers can wreak havoc on businesses and individuals. Here, an expert helps readers recognize the signs of a would-be criminal in their midst. Focusing on the perpetrators, the author provides information about how they operate, why they do it, what they hope to do, and how to protect yourself from becoming a victim.

Anterior eye health recording

Aims: To survey eye care practitioners from around the world regarding their current practice for anterior eye health recording to inform guidelines on best practice. Methods: The on-line survey examined the reported use of: word descriptions, sketching, grading scales or photographs; paper or computerised record cards and whether these were guided by proforma headings; grading scale choice, signs graded, level of precision, regional grading; and how much time eye care practitioners spent on average on anterior eye health recording. Results: Eight hundred and nine eye care practitioners from across the world completed the survey. Word description (p <. 0.001), sketches (p = 0.002) and grading scales (p <. 0.001) were used more for recording the anterior eye health of contact lens patients than other patients, but photography was used similarly (p = 0.132). Of the respondents, 84.5% used a grading scale, 13.5% using two, with the original Efron (51.6%) and CCLRU/Brien-Holden-Vision-Institute (48.5%) being the most popular. The median features graded was 11 (range 1-23), frequency from 91.6% (bulbar hyperaemia) to 19.6% (endothelial blebs), with most practitioners grading to the nearest unit (47.4%) and just 14.7% to one decimal place. The average time taken to report anterior eye health was reported to be 6.8. ±. 5.7. min, with the maximum time available 14.0. ±. 11. min. Conclusions: Developed practice and research evidence allows best practice guidelines for anterior eye health recording to be recommended. It is recommended to: record which grading scale is used; always grade to one decimal place, record what you see live rather than based on how you intend to manage a condition; grade bulbar and limbal hyperaemia, limbal neovascularisation, conjunctival papillary redness and roughness (in white light to assess colouration with fluorescein instilled to aid visualisation of papillae/follicles), blepharitis, meibomian gland dysfunction and sketch staining (both corneal and conjunctival) at every visit. Record other anterior eye features only if they are remarkable, but indicate that the key tissue which have been examined.

Herman Chinery-Hesse:the Bill Gates of Ghana?

Herman Chinery-Hesse considers his plans for a new venture, a virtual mall that would enable African producers to sell their products worldwide through a new international payment system based on mobile phones and pre-paid scratch cards. In 2010, his operating company, Black Star Lines (BSL) Ghana Ltd is considering plans to launch shopAfrica53.com, and associated payment and distribution services in Ghana and the UK. This case teaches new approaches to poverty reduction through the realisation of entrepreneurial opportunities at the Bottom of the Pyramid (BoP) and is suitable for courses on social enterprise, entrepreneurship in general, and development studies seeking to incorporate more private sector approaches. It can also be adapted for courses such as international strategy or technology business.