Outcomes: essential information for clinical decision support: an interview with Ellen B. White. Interview by Melinda L. Orlando

There is an increasing demand for outcomes data from both purchasers of health care and providers. This is especially true for the managed behavioral health care industry. Patients are more educated about health care and active in treatment decisions. Patient-reported outcomes data, clinical information, and functional status are components of the clinical decision support system. This article describes, in interview format, an outcomes measurement system for clinical decision support.     

Hydroxamate-based metalloprotease inhibitor blocks shedding of L-selectin adhesion molecule from leukocytes: functional consequences for neutrophil aggregation

L-selectin is an adhesion molecule that mediates the recruitment of neutrophils to inflammatory sites and initiates the migration of lymphocytes into the peripheral lymph nodes. In response to cell activation, L-selectin is shed from the cell surface, and altered levels of functional soluble L-selectin are detected in the plasma of patients suffering from numerous inflammatory diseases as well as AIDS. The mechanism that regulates L-selectin shedding is poorly understood. Here we show that a hydroxamate-based metalloprotease inhibitor, N-(D,L-[2-(hydroxyaminocarbonyl)- methyl]-4-methylpentano)-L-3-(tert-butyl)-alanyl-L-alanine, 2-aminoethyl amide, which blocks leukocyte TNF, TNF receptor, and IL-6 receptor release, also inhibits L-selectin shedding from neutrophils, eosinophils, and lymphocytes. Moreover, we show that such inhibition of L-selectin shedding profoundly affects neutrophil aggregation and permits reaggregation in the presence of a heterologous stimulus.     

Antimicrobial properties of pectins and their effects on antibiotics

The influence of food fibres and plant proteins on microorganisms, bacteriophages, antibiotics and penicillinase was studied in vitro. It was shown that pectin was the only agent that had a bactericidal effect on the most widely distributed pathogenic and opportunistic microorganisms and did not influence indigenic microflora. High concentrations of pectin (> 2 per cent) had an inactivating effect on therapeutic bacteriophages. There was also a decrease in the antimicrobial activity of penicillins. The other agents tested i.e. wheat bran, soya isolate and soybean flour had no influence on microorganisms, bacteriophages and antibiotics. No sorption activity of the food fibres and plant proteins with respect to microorganisms and antibiotics or their effect on penicillinase was observed.     

Monitoring drug concentrations in a case of combined overdosage with primidone and methsuximide

We describe a case of fatal overdosage with primidone and methsuximide. During the early phase of the patient's hospital course we found concentrations of methsuximide, N-desmethylmethsuximide, and primidone in serum that far exceeded the usual therapeutic concentrations, as determined by gas-liquid chromatography. Determination of N-desmethylmethsuximide in peritoneal fluid demonstrated concentrations comparable to those in serum. This led to the therapeutic decision to manage the patient by dialysis. Subsequently, serum samples collected during the course of hospitalization were analyzed quantitatively by gas-liquid chromatography for methsuximide, N-desmethylmethsuximide, primidone, phenobarbital, and diphenylhydantoin. Selected serum specimens were also analyzed by gas chromatography-mass spectrometry, and N-methyl-2-hydroxymethyl-2-phenylsuccinimide, a metabolite of methsuximide not previously described in human serum, was identified by analysis of its mass spectrum.