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Chronic Renal Disease Caused by Cisplatin, Folic acid b vitamin and Renal Ischemia Reperfusion Induces Anemia and also Stimulates GATA-2 Initial within Mice.
This is achieved with techniques ranging from classic load balancing (often geared to reduce communication overhead) to exploring trade-offs between delaying computation and relaxing accuracy. In this survey we firstly familiarize the reader with common graph datasets and applications in the world of today. We provide an overview of different aspects of the graph processing landscape and describe classes of systems based on a set of dimensions we describe. The dimensions we detail encompass paradigms to express graph processing, different types of systems to use, coordination and communication models in distributed graph processing, partitioning techniques and different definitions related to the potential for a graph to be updated. This survey is aimed at both the experienced software engineer or researcher as well as the graduate student looking for an understanding of the landscape of solutions (and their limitations) for graph processing.The interaction between methadone and central nervous system depressants can cause serious adverse effects, including profound sedation, respiratory depression, coma, and death. This poses a challenge in the treatment of patients with concurrent psychiatric and substance use disorders as the combined use is often unavoidable. We report a case of a patient with opioid use disorder, mood disorder unspecified, chronic pain, and chronic obstructive pulmonary disease who experienced 2 serious episodes of CNS and respiratory depression due to polypharmacy-induced opioid toxicity. Careful consideration of pharmacokinetics, pharmacodynamics, and patient-specific factors was imperative to identify the suspected contributing medications methadone, lorazepam, divalproex, gabapentin, and cyclobenzaprine. Cognitive and system factors that contributed to these adverse events and strategies to mitigate risk of recurrence were also identified.
Despite the high prevalence of those with mental illnesses, there is a critical shortage of psychiatric providers in the United States. Psychiatric pharmacists are valuable members of the health care team who meet patient care needs, especially those practicing with prescriptive authority (PA).

A cross-sectional electronic survey was administered to Board Certified Psychiatric Pharmacists (BCPPs) and non-BCPP members of the College of Psychiatric and Neurologic Pharmacists. The objective of this study was to compare demographic and practice characteristics between respondents with and without PA.

Of the 334 respondents, 155 (46.4%) reported having PA. Those with PA, including those with Veterans Affairs (VA) affiliated PA, had fewer mean number of years of licensure than those without PA (
 = .008 and
 = .007, respectively). The majority with PA practiced in outpatient settings (53.5%). Respondents with PA (including those with VA-affiliated PA) were more likely to have their positions funded by praced treating psychiatric and medical conditions, creating added value. Psychiatric pharmacists should be empowered to track outcomes and help meet the critical shortage of psychiatric providers.
This quality improvement initiative aimed to implement a strategy to increase access to care with clinical pharmacy specialists (CPSs), optimize CPS direct patient care activities, and promote clinical pharmacy services. The primary objective was to assess the impact of patient marketing on expanding access to care and clinic utilization in a CPS clinic.

A marketing technique was applied by a mental health (MH) CPS to expand clinical pharmacy services. Direct-to-patient brochures advertising MH CPS comprehensive medication management services were placed at the check-in window of an interdisciplinary outpatient MH clinic. Brochure content included a description of an MH team, the role of MH CPSs, and benefits of being managed by MH CPSs. Patients could contact the MH CPS or speak to their primary provider for referral. The preintervention and postintervention evaluation periods were 4-month time frames. Clinic utilization for the MH CPS clinic was compared before and after dissemination of marketing brochures. Additional outcomes evaluated were number of encounters, number of patients seen, and number of clinical interventions completed by the MH CPS.

There was a significant increase in clinic utilization postintervention. The total number of encounters, patients, and clinical interventions were numerically increased postintervention.

The observed improvements in clinic utilization suggest the benefit of marketing in optimization of access to care in CPS clinics and justification of clinical pharmacy services.
The observed improvements in clinic utilization suggest the benefit of marketing in optimization of access to care in CPS clinics and justification of clinical pharmacy services.
Patients with mental illness are particularly at risk for OUD, and due to this higher risk, providers may be more inclined to withhold their home opioids when they are admitted to a psychiatric hospital. Patients whose home opioids are continued or withheld during admission may be treated differently with respect to pain control, orders for nonopioid adjunctive pain agents, orders for intramuscular as-needed medications, orders for seclusion and/or restraints, and outpatient referrals for OUD treatment. The objective of this retrospective pilot study was to characterize inpatient care for these 2 patient populations.

Thirty-one inpatient encounters were reviewed for patients who had opioid prescriptions before admission and were discharged from the medical center's psychiatric service from June 1 through August 31, 2019.

Orders for nonopioid adjunctive pain agents and intramuscular as-needed medications trended higher for the opioid-withheld group, suggesting greater polypharmacy and patient dissatisfaction compared with the opioid-continued group. Additionally, what became evident was the lack of consistent and clear documentation regarding the discharge plans for the patients' home opioid and OUD treatment.

These findings may prompt inpatient interdisciplinary teams to develop a better process of documentation to facilitate continuity of care.
These findings may prompt inpatient interdisciplinary teams to develop a better process of documentation to facilitate continuity of care.
This study aimed to compare the rates of agitation-related interventions associated with initial holding versus continuation of home stimulant(s) in a child and adolescent population at the time of admission to an inpatient psychiatric facility.

This retrospective chart review included patients less than 18 years of age who were admitted to an academic medical center between July 1, 2017, and July 1, 2018. Patients were divided into 2 groups those continued on their home stimulant(s) and those who had them held. We compared both groups on agitation-related outcomes by examining the difference in the number of level I or II events or as-needed medication administrations. Mechanical restraints and closed-door seclusions were grouped as level I events, and level II events consisted of nonmechanical restraint.

The analysis included 169 patients. In total, 126 (75%) patients were continued on their home stimulant, and 43 (25%) had them held. The occurrence of the composite endpoint of level I or II events or as-needed intramuscular medication administration was numerically higher in the group that had their home stimulant held (27.9% vs 23%;
 = .52). Level I events were also numerically higher but not statistically significant in the group that had their home stimulant held (16.3% vs 11.9%;
 = .46).

The composite outcome of as-needed intramuscular medication administration and level I or II events was numerically higher in the group that had their home stimulant held. Use of a larger sample size and adjusted analyses may help elucidate covariates that impact agitation-related outcomes.
The composite outcome of as-needed intramuscular medication administration and level I or II events was numerically higher in the group that had their home stimulant held. Use of a larger sample size and adjusted analyses may help elucidate covariates that impact agitation-related outcomes.
Knowledge about fundamental sleep disorders and dysregulation that occurs in children with PTSD is limited. Prazosin is an alpha-1 receptor antagonist often used off label for the treatment of PTSD-associated nightmares in adults; however, evaluation of its use in pediatrics and adolescents is limited. The primary objective of this study was to assess the impact of prazosin on nightmares associated with PTSD in this population. Secondary objectives included assessing side effects, changes in blood pressure, and 30-day readmission rates.

This was a retrospective, single-center chart review of inpatients diagnosed with PTSD nightmares from January 1, 2017, to July 31, 2019. Patients 4 to 18 years old with a PTSD diagnosis, experiencing nightmares, and initiating any dose of prazosin were assessed to determine efficacy and tolerance.

Forty-two patients were evaluated to determine symptom improvement after initiation of prazosin for PTSD nightmares in children and adolescents. Of the 42 patients, 24 (57.1%)of prazosin.
Chlorpromazine is a first-generation antipsychotic used for behavioral problems in pediatric patients. However, other therapies may demonstrate both improved outcomes and fewer side effects. Within our institution, chlorpromazine has been the standard medication used for treatment of pediatric agitation. The study objective was to evaluate the appropriateness of chlorpromazine use (including efficacy, appropriate dosing, drug interactions, and tolerability) to optimize the treatment of pediatric agitation.

Data regarding drug interactions, patient behavior, dosing, and side effects was collected for each patient administered chlorpromazine from January 2019 through June 2019. Data were analyzed using descriptive statistics assessing the incidence of drug-drug interactions (DDIs), incidences of inefficacy, inappropriate dosing, and side effects.

A total of 70 patients and 130 administrations of oral or intramuscular chlorpromazine were evaluated. Of these administrations, 49 (38%) resulted in a DDI. Eighteen (14%) administrations were ineffective for managing symptoms of agitation. check details Eleven (8%) administrations were dosed inappropriately, and 46 (35%) administrations resulted in side effects possibly caused by chlorpromazine.

Results from this study demonstrate opportunities for improvement in patient care due to instances of drug interactions, inefficacy, inappropriate dosing, and side effects with the use of chlorpromazine.
Results from this study demonstrate opportunities for improvement in patient care due to instances of drug interactions, inefficacy, inappropriate dosing, and side effects with the use of chlorpromazine.The present study discusses opioid-induced constipation (OIC) in advanced cancer patients, focusing on the OIC definition, pathophysiology, and treatment. OIC is any change from baseline defecation patterns and bowel habits that developed after starting opioid therapy. The condition is characterized by bowel frequency reduction, worsening or development of straining, a sensation of incomplete defecation, or distress associated with bowel habits. OIC is common in advanced cancer patients, with a prevalence of approximately 51%-87% in patients taking opioids for pain management. Patients are likely to experience severe distress, work productivity reduction, poor quality of life, and increased healthcare utilization. OIC has a complex pathophysiology that involves propulsive and peristalsis impairment, intestinal mucosal secretion inhibition, intestinal fluid absorption enhancement, and anal sphincters function impairment. The Rome III criteria are used to assess and diagnose clinical OIC and can also be diagnosed through the Patient Assessment of Constipation (PAC) measures, including the symptom survey (PAC-SYM) and quality of life survey (PAC-QOL).
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