Objective Congenital left ventricular aneurysm (LVA) and diverticulum (LVD) are rare cardiac anomalies. We aimed to analyse the characteristics and long‐term outcome of prenatal diagnosed patients with LVA/LVD. Methods We performed a systematic review of the literature to identify and analyse patients diagnosed prenatally with LVA/LVD. Results Twenty‐six fetuses with prenatal diagnosis of LVA (50% male subjects) and 16 with LVD (38% male subjects) were identified. Fetal age at diagnosis was 23.8 ± 6.1 weeks. Mean maternal age was 30.6 ± 6.1 years old. LVA was larger (375 ± 237 vs 60 ± 71 mm 2 ; p = 0.002), and LVA/LVD was frequently observed in an apical location (62%). Associated cardiac/extracardiac defects were reported in 13/42 (31%). Symptomatic patients presented with arrhythmias (LVA 16% vs LVD 0%), hydrops fetalis (LVA 27% vs LVD 18.8%), or rupture (LVA 4% vs LVD 38%; p = 0.02). Size changes of the LVA/LVD during pregnancy were reported in 17%. Fetal death occurred in nine cases (21.4%); termination of pregnancy was performed in six cases (14.3%). All other babies were delivered at term. During follow‐up (mean 29.1 ± 38.2 months), the rate of adverse events was significantly increased in patients with LVA (40 vs 0%; p = 0.04) Conclusion The rate of fetal complications including fetal death is high. Long‐term outcome among the survivors is significantly worse in patients with LVA. © 2014 John Wiley & Sons, Ltd.
Objective The aim of this study was to evaluate the utility of screening for infections in case of isolated mild ventriculomegaly (imVM). Methods We retrospectively reviewed 141 cases of imVM. Screening for infections including TORCH, parvovirus B19, and syphilis was carried out in all cases. Follow‐up ultrasound, fetal karyotype, and magnetic resonance imaging (MRI) were offered. Postnatal follow‐up was obtained from pediatricians, medical records, parents, and postmortem reports in cases of termination of pregnancy or stillbirth. Results The imVM was bilateral in 70 fetuses and unilateral in 71 and regressed during pregnancy in 66.6% of cases. Associated anomalies were observed in 15 cases with follow‐up ultrasound and in seven cases with MRI. Fetal karyotype was abnormal in one fetus (47, XXY). Maternal IgM for parvovirus B19 resulted positive in 4.6% of cases, and one neonate was infected without any fetal/neonatal adverse consequence. Recent cytomegalovirus infection was documented in 4.4% of cases. Only in one case the infection was transmitted to the fetus; after 3 years, the child has good neuromotor development but has severe hearing impairment. Conclusions When this diagnosis occurs, tests could be limited to cytomegalovirus and parvovirus B19, whereas a complete TORCH screening is probably not necessary. © 2014 John Wiley & Sons, Ltd.
Purpose Emergency department (ED) patients receive medications that place them at risk for adverse events, including drug‐induced prolongation of the QT interval, which can lead to Torsade de Pointes and sudden cardiac death. We report the frequency of prescription and co‐prescription of QT‐prolonging medications in US EDs and factors associated with high‐risk prescribing practices. Methods We analyzed the ED component of the National Hospital Ambulatory Medical Care Survey for 1995 through 2009. Yearly rates of visits involving the prescription of QT‐prolonging medications were determined. Multivariate regression analyses identified factors associated with the prescription of two or more QT‐prolonging medications. Results Approximately 16.5 million visits annually (15.0%) involved prescription of a QT‐prolonging drug, with 1.7 million (1.6%) involving multiple prescriptions. Visits associated with QT‐prolonging drugs more than doubled over the study period (10.4% to 22.2%). Diphenhydramine, azithromycin, and ondansetron were most frequently implicated (46.1% of cases). The most commonly prescribed combination was diphenhydramine and famotidine, both QT‐prolonging medications available over‐the‐counter. Female gender and older age were associated with co‐prescription of QT‐prolonging medications. The rate of EKG screening among visits associated with QT‐prolonging drug combinations was low (20.9%), but more common than among visits without a QT‐prolonging drug (OR 1.3; 95% CI 1.2–1.5). Conclusion Use of QT‐prolonging medications is increasing in EDs nationally. A small number of agents account for a large proportion of these visits and may represent an area for targeted screening or monitoring interventions in the ED. Copyright © 2013 John Wiley & Sons, Ltd.
It is the position of the A merican C ollege of C linical P harmacy ( ACCP ) that formal postgraduate residency training, or equivalent experience, is required to enter direct patient care practice. Therefore, it is important to align professional degree educational outcomes with the knowledge, skills, and attitudes needed to enter residency training. This position statement addresses the outcomes necessary in the professional degree program curriculum to ensure the ability of pharmacy graduates to transition effectively into postgraduate year one residency training. Five key outcome areas are identified: communication, direct patient care, professionalism, research, and practice management. The position statement examines how performance in each of the five outcome areas should be addressed by professional degree programs. The ACCP believes that for the student to achieve the clinical proficiency necessary to enter residency training, the professional degree program should emphasize, assess, and provide adequate opportunities for students to practice: communication with patients, caregivers, and members of the health care team in direct patient care environments; provision of direct patient care in a wide variety of practice settings, especially those involving patient‐centered, team‐based care; professionalism under the supervision and guidance of faculty and preceptors who model and teach the traits of a health care professional; application of principles of research that engender an appreciation for the role of research and scholarship in one's professional development; and application of practice management, including documentation of direct patient care activities that affect drug‐related outcomes.
The use of levetiracetam for the treatment of epilepsy in women of childbearing age has increased as more evidence of teratogenicity of other broad‐spectrum antiepileptic medications becomes available. Levetiracetam appears to be associated with a low incidence of major congenital malformations based on data from pregnancy registries. Major pregnancy‐related changes in the pharmacokinetics of levetiracetam have been described in several case series, demonstrating a role for careful therapeutic drug monitoring of levetiracetam in pregnant patients. Extended‐release levetiracetam provides a way to improve medication adherence in adults with epilepsy by allowing once/day dosing and may be considered for use in pregnancy to minimize the fluctuation of levetiracetam levels throughout the day, thus potentially minimizing dose‐related adverse effects. In this case report, we describe a 16‐year‐old, compliant, pregnant patient who experienced subtherapeutic levetiracetam blood concentrations that occurred with use of extended‐release levetiracetam. She experienced a breakthrough seizure with once/day dosing during her third trimester with low subsequent trough levels despite multiple dose increases. After changing to twice/day dosing of extended‐release levetiracetam at delivery, the patient experienced no seizures and delivered a healthy infant without complications. This is the first case report, to our knowledge, to describe seizure breakthrough during pregnancy with an extended‐release formulation of an antiepileptic medication. Pharmacokinetic changes associated with pregnancy may increase apparent clearance of extended‐release formulations of levetiracetam, leading to periods of subtherapeutic blood or central nervous system concentrations. These changes support the important role of therapeutic monitoring of levetiracetam plasma concentrations to help maintain seizure control in women with epilepsy during pregnancy.
Introducing chiral hierarchical structures in polymer materials and polymer surfaces unlocks additional properties and functionalities in a range of applications in nanoscience, biomedicine and biomaterials. (All M.C. Escher works © 2013 The M.C. Escher Company ‐ the Netherlands. All rights reserved. Used by permission. www.mcescher.com .)
As part of our series on the major psychiatric medication groups, produced in association with the College of Mental Health Pharmacy (CMHP; www.cmhp.org.uk ), Michele Sie discusses the choice and use of medicines in the management of bipolar affective disorder. Pharmacology, interactions and side‐effects, as well as information to give to patients, are described.
Objectives Body image is a critical issue for cancer patients undergoing reconstructive surgery, as they can experience disfigurement and functional impairment. Distress related to appearance changes can lead to various psychosocial difficulties, and patients are often reluctant to discuss these issues with their healthcare team. Our goals were to design and evaluate a screening tool to aid providers in identifying patients who may benefit from referral for specialized psychosocial care to treat body image concerns. Methods We designed a brief four‐item instrument and administered it at a single time point to cancer patients who were undergoing reconstructive treatment. We used simple and multinomial regression models to evaluate whether survey responses, demographic, or clinical variables predicted interest and enrollment in counseling. Results Over 95% of the sample ( n = 248) endorsed some concerns, preoccupation, or avoidance because of appearance changes. Approximately one‐third of patients were interested in obtaining counseling or additional information to assist with body image distress. Each survey item significantly predicted interest and enrollment in counseling. Concern about future appearance changes was the single best predictor of counseling enrollment. Sex, age, and cancer type were not predictive of counseling interest or enrollment. Conclusions We present initial data supporting use of the Body Image Screener for Cancer Reconstruction. Our findings suggest benefits of administering this tool to patients presenting for reconstructive surgery. It is argued that screening and treatment for body image distress should be provided to this patient population at the earliest possible time point. Copyright © 2014 John Wiley & Sons, Ltd.