No abstract

The use of a 30-mL/min (0.50-mL/s) cutoff is not justified, on the basis of currently available evidence, to select individuals at increased risk of accumulation when LMW heparin is used. The pharmacokinetic response to impaired renal function may differ among LMW heparin preparations.

Ontario Ministry of Health and Long-Term Care.

Objective. To measure changes in interprofessional competencies among pharmacy and medical students following a half-day event focusing on interprofessional learning. Methods. There were 118 pharmacy students and 28 medical students who participated in the Healthcare Interprofessional Education Day (HIPED) which consisted of three stations (communication, patient interviewing, and prescribing) in which pharmacy and medical students had to work collaboratively. The standardized Interprofessional Collaborative Competency Attainment Survey (ICCAS) was used to evaluate the effectiveness of the program.Results. There were 133 surveys completed for a response rate of 91%. All 20 items measured by the ICCAS showed a significant improvement. The strongest effect sizes were in the collaboration, roles & responsibilities, and collaborative practice/family-centered approach categories. The least robust effects were in the conflict management/resolution category. Conclusion. The HIPED activity was an effective IPE experience. The strong and consistent improvement in all ICCAS scores suggest a framework for pharmacy and medical school training to move from siloed educational experiences to synergistic learning opportunities.

An 80-year-old woman and a 79-year-old man underwent urgent percutaneous coronary intervention and received adjunctive eptifibatide. Platelet counts in both patients fell to below 20 x 10(3)/mm3 within 4 hours of eptifibatide administration. Reports in the medical literature reinforce the importance of recognizing that eptifibatide can cause acute profound thrombocytopenia. All three available glycoprotein IIb-IIIa inhibitors--abciximab, eptifibatide, and tirofiban--have been associated with the development of this disorder. Thus, clinicians should routinely monitor platelet counts in patients receiving glycoprotein IIb-IIIa inhibitors within 2-4 hours of the start of the infusion.

No abstract

No abstract

Background Clinical practice guidelines for the treatment of hypertension recommend a thiazide diuretic as initial therapy for the majority of patients. Most clinicians consider chlorthalidone (CHL) and hydrochlorothiazide (HCTZ), the two most commonly prescribed thiazides, to be interchangeable, despite evidence suggesting these drugs are not equivalent. Methods We constructed a population-based retrospective cohort study by linking the health records of 1.4 million residents of Ontario, Canada aged 66 or older between July 1, 1993 and March 1, 2002. The index event for entry into the cohort was a new prescription for either HCTZ or CHL. The primary outcome was the time from the index event to a composite outcome of acute myocardial infarction (AMI), stroke, or all-cause mortality. Secondary analyses explored each outcome individually. Analysis was done using Cox proportional hazards regression with the HCTZ group as the reference. Results During 218,360 person-years of follow-up in the HCTZ group, there were 10 025 events (death, AMI or stroke), compared to 113 events during 4,214 person-years of follow-up in the CHL group. The unadjusted hazard ratio for the primary outcome was 0.73 (95% confidence interval 0.61 to 0.88), suggesting a substantially lower risk of events during CHL therapy. After adjustment for differences in baseline demographic and clinical characteristics, there was no statistically significant difference between the groups for the primary outcome (adjusted hazard ratio 0.85; 95% confidence interval 0.71 to 1.03). The hazard ratios for each component of the primary composite outcome all trended in the direction of a lower risk of events in users of CHL. Conclusion In a large cohort of older patients treated with thiazide diuretics, the use of CHL was not associated with a statistically significant reduction in the risk of AMI, stroke, or death. However, treatment effects favored CHL for every outcome, raising the hypothesis that CHL is superior to HCTZ. Further research is needed to confirm or refute this hypothesis.