Background: Tapentadol (TAP) and tramadol (TRA) provide pain relief through similar monoaminergic and opioid agonist properties. Objective: To compare clinical effects and medical outcomes between TAP and TRA exposures reported to the National Poison Data System of the American Association of Poison Control Centers. Methods: A retrospective cohort study was conducted analyzing national data for single medication TAP or TRA cases reported from June 2009 through December 2011. Case outcomes, dichotomized as severe versus mild; clinical effects; and use of naloxone were compared. Results: There were 217 TAP and 8566 TRA cases. Significantly more severe outcomes were associated with TAP exposures for an all-age comparison (relative risk [RR] = 1.24; 95% CI = 1.04-1.48), and for the <6-year-old age group (RR = 5.76; 95% CI = 2.20-15.11). Patients with TAP exposures had significantly greater risk of respiratory depression (RR = 5.56; 95% CI = 3.50-8.81), coma (RR = 4.16; 95% CI = 2.33-7.42), drowsiness/lethargy (RR = 1.38; 95% CI = 1.15-1.66), slurred speech (RR = 3.51; 95% CI = 1.98-6.23), hallucination/delusion (RR = 7.25; 95% CI = 3.61-14.57), confusion (RR = 2.54; 95% CI = 1.56-4.13) and use of naloxone (RR = 3.80; 95% CI = 2.96-4.88). TRA exposures had significantly greater risk of seizures (RR = 7.94; 95% CI = 2.99-20.91) and vomiting (RR = 1.96; 95% CI = 1.07-3.60). Conclusion: TAP was associated with significantly more toxic clinical effects and severe outcomes consistent with an opioid agonist. TRA was associated with significantly higher rates of seizures and vomiting.

A 23-year-old man was brought to the emergency department after eating four boxes of brodifacoum-containing rodenticide over a 4-day interval and pieces from approximately two bottles of glass over the previous 2 weeks. He was asymptomatic but his prothrombin time was markedly elevated with an international normalized ratio (INR) of 37.8. A plain abdominal film showed diffuse radiopaque foreign bodies, presumably glass, in the large and distal small intestines. Treatment for ingested glass consisted of stool softeners and bulk-forming laxatives. The patient developed mild gingival bleeding and received fresh frozen plasma (FFP) infusions and vitamin K1 orally. At a vitamin K1 dosage of 300 mg/day, the INR corrected to less than 2.0 and the patient was discharged taking that dosage. He returned 26 days later with hematuria and flank pain, and his INR was 189. He was administered FFP and packed red blood cells, and his vitamin K1 dosage was increased to 800 mg/day; his INR returned to baseline. Compliance with taking the vitamin K1, which required ingestion of 60-160 tablets/day, was a serious problem, requiring numerous follow-up calls and visits to the patient at home and work. At 5-month follow he was doing well. Compliance with large daily doses of vitamin K1 for treatment of "superwarfarin" ingestion may be poor because of the duration of treatment and large number of pills required. A more concentrated formulation may be advantageous for management of patients with brodifacoum poisoning.

Pharmaceutical medical information contact centers are often a key interface among a company, the medical community, and the general public. Results fiom three benchmarking surveys are reviewed. The surveys were designed to provide contact center leaders with unbiased and relevant information for use in assessing operations and setting strategic direction. The surveys were similar in f m s and conducted at three time points (2004,2005, and 2008). The surveys focused on the organizational structure and operations, sourcing options, technology, and globalization. These findings provide not only a snapshot of current contact centers, but also a view over time of the progression of changes to organizational and operational processes of medical infor-mation contact centers. The trends and challenges faced by pharmaceutical medical information contact centers included (a) increasing efficiency and productivity of the process to handle increased call volumes to meet customer expectations; (b) creating or maintaining a validated environment for business processes and systems to improve service, efficiency, and compliance; (c) utilizing outsourcing options, including offshore or international contact centers, to help maintain costs and obtain flexibility; and last (d) continuing to add and show value to the overall organization. This information is presented as a resource as contact centers develop and refine strategies for managing in today's challenging environment.

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This artide pmvides an update to the published instructor's notes for the Core Chicdm tutorial prvscnted mvII(Qay at the Dnrg lnfmnation Association medical conummiccctions d o p . lhe opiginal pubficatim has bccomc the foundation for tmimng individuals new to industry k e d drug information pmcticc. This up&rtc to the Con M c u h a n publication dcscribcs the cvdvingrdeofmedicalcommunicationspfessionals, highlQ$ting dumgcr j b n the original puMication that imptact the con rde of a medical communicutions pfessional as d as describing new &ties.Medical aomnnmicationS departments play a d e thracghout a promcct's devdopment and life cyde. They m e both atanal customas and intemaf busincss pmtnas with various SQViccp. This attide nvicrvs these customers and parinus and higldights va?iw activities that medid awnmnications crm be invohrcd in sud~ as pmmotbtal nview, scientific mating support, tmining product labding support, publication planning, medical cmccation, dimcal trial racndtmcnt, CmdposbuuWngdinical cxRnmunications (inchding Academy of Managed canphamacy dossiadevdopment). Additional support of posbuuWng progmnrs indudes i h e n t with safdy ~ mmurgcment, fidd-bad medical groscps (medical liaison teums), and tmining. Kry Words Medical information; Medical communications; Core Cum'culum Corrrspondrncr Addrrsr Stacey M. Fung. PharmD, Genentech, Inc.. I DNA Way, South San Francisco. CA 94080 (email: fung.stacey-m @gene.com).