Sickle cell disease is a life-limiting inherited hemoglobinopathy that poses inherent risk for surgical complications following cardiac operations. In this review, we discuss preoperative considerations, intraoperative decision-making, and postoperative strategies to optimize the care of a patient with sickle cell disease undergoing cardiac surgery.
Objectives This study aimed to determine the information needs and reported adherence of patients prescribed medicines for chronic conditions in those who have received a community pharmacy advanced service and those who have not.Methods A questionnaire was constructed using validated tools to measure medication information satisfaction and adherence together with questions eliciting information regarding the use of pharmacy services and demographic characteristics. This questionaire was distributed from four community pharmacies to a convenience sample of 400 patients as they collected their medicines. Patients were eligible if prescribed more than one regular medicine and attending the pharmacy for longer than three months. The questionnaire was returned directly to the university.Key Findings 232 (58%) questionnaires were returned. All respondents desired further information about their prescribed medicines, particularly about potential medication problems. Dissatisfaction centred on side effects, interactions and certain medicine characteristics such as how long it will take to act. Satisfaction with information about medicines and adherence were significantly greater in a subgroup reporting that they had received an advanced pharmacy service e.g. medicine use review.
ConclusionPatients who had received an advanced service reported greater adherence and satisfaction with medicine related information. This was a small, observational study, using a convenience sample of four pharmacies; in order to draw definitive conclusions, a larger study with participants randomised to receive an advanced service is required.
BackgroundOveractive bladder (OAB) is often associated with a number of co-morbid medical conditions, including diabetes mellitus. This may necessitate several concomitant treatments, thus creating the potential for drug–drug interactions (DDIs). Trospium is renally eliminated, not metabolized via cytochrome P450; therefore, cytochrome P450 DDIs are unlikely. However, coadministration with another renally eliminated drug (e.g., metformin) may theoretically result in a DDI.ObjectiveThe objective of this study was to evaluate the pharmacokinetics (plasma and urine) and safety/tolerability of the coadministration of trospium chloride extended release (XR) and metformin under steady-state conditions in healthy male and female subjects.MethodsIn a single-centre, randomized, open-label, two-group, two-period study in healthy males and females aged 18–45 years, 44 subjects received oral metformin 500 mg twice daily for 3.5 days during one period, and oral trospium chloride XR 60 mg once daily for 10 days, followed by trospium chloride XR 60 mg once daily for 4 days plus metformin 500 mg twice daily for 3.5 days during the other period. The two periods occurred in a crossover fashion, separated by a 3-day washout period.ResultsTrospium chloride XR coadministration did not alter metformin steady-state pharmacokinetics. Metformin coadministration reduced trospium steady-state maximum plasma concentration (by 34 %) and area under the concentration–time curve from 0–24 hours (by 29 %). Neither drug’s renal clearance was affected. No safety/tolerability issues of concern were observed with coadministration.ConclusionNo dosage adjustment is necessary for metformin when coadministered with trospium chloride XR.
Cloud computing is very popular across the world. It helps in solving challenges faced by small and large scale enterprises in term of cost-effectiveness, security, availability and Information Technology resources . E-commerce in Small and medium enterprises is need to serve the customers better services to satisfy them and provide them customized services. From last two decades these Small and medium enterprises faced many issues and challenges. The different cloud services as discussed to provide better platform to e-commerce applications. The technical issues related to the e-commerce are addressed in this paper. Further this paper proposed the solution of same problems with services of cloud computing. The issues and challenges that Ecommerce enterprises are facing are elaborated, and how cloud computing can be useful to enhance business with cloud computing.
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