OBJECTIVE: To review current challenges to the provision of safe and effective pharmaceutical care in assisted living facilities. DATA SOURCES: Current literature. DATA SYNTHESIS: The assisted living industry has expe...
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OBJECTIVE: To review current challenges to the provision of safe and effective pharmaceutical care in assisted living facilities. DATA SOURCES: Current literature. DATA SYNTHESIS: The assisted living industry has experienced tremendous growth and offers pharmacists lucrative business opportunities. However, pharmacists must understand the varied nature of both the facilities and the residents. Assisted living residents are entitled to independence and privacy, a fact that presents many challenges in terms of monitoring the safe and accurate administration of medications. CONCLUSION: Assisted living facilities provide elderly residents a new and unique blend of independent living and daily support. To provide effective pharmacy services to these facilities, pharmacists must consider their specific needs in terms of medication use processes, packaging, delivery, documentation, and storage.
beta-Cell function in growth hormone (GH)-deficient (GHD) adults is poorly documented. beta-Cell function was therefore studied in 10 GHD adults (age, 40 +/- 3 years;weight, 79.3 +/- 4.8 kg;body mass index [BMI], 27.5...
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beta-Cell function in growth hormone (GH)-deficient (GHD) adults is poorly documented. beta-Cell function was therefore studied in 10 GHD adults (age, 40 +/- 3 years;weight, 79.3 +/- 4.8 kg;body mass index [BMI], 27.5 +/- 1.3 kg . m(-2)) before and after 6- and 24-month recombinant human GH (rhGH) therapy (0.24 IU . kg(-1) . wk(-1)) compared with 10 age-, sex-, weight-, and BMI-matched control subjects. With rhGH therapy, fat-free mass (FFM) increased (48.2 +/- 4.9, 52.5 +/- 4.8, and 59 +/- 6.8 kg, respectively) and fat mass (FM) decreased (33.8% +/- 2.8%, 28.0% +/- 3.0%, end 29.4% +/- 2.5%, respectively), as did serum cholesterol. Oral glucose tolerance initially deteriorated at 6 months, but improved toward the control value by 24 months. Fasting insulin (FI) increased significantly, as did the acute insulin response to oral glucose (Delta AIR(OGTT)/Delta G) at 30 minutes (FI: pretreatment 9.8 +/- 0.8, 6 months, 14.0 +/- 1.8, 24 months 12.5 +/- 1.6 v control 11.4 +/- 1.9 mU . L-1;Delta AIR(OGTT)/Delta G: pretreatment 201 +/- 24, 6 months 356 +/- 41, 24 months 382 +/- 86 v control 280 +/- 47 mU . mmol(-1)). However, the acute insulin response to intravenous (IV) glucose (AIR(G)) and IV glucagon at euglycemia and hyperglycemia did not change with rhGH therapy and were similar to the control group values. Importantly, the expected reciprocal relationships (as observed for the control group) between the various insulin secretory parameters and insulin sensitivity (SI) either were not present or were statistically weak in GHD subjects, despite the 35% decrease in SI by 24 months of rhGH therapy. In particular, over time, there was an attenuation of insulin secretion with respect to the ongoing insulin resistance with rhGH therapy, particularly for AIRG at 24 months. After 5 days of rhGH withdrawal, insulin secretion decreased and SI improved in GHD subjects. It is concluded that the current long-term rhGH treatment regimens appear to impact on insulin secretion such th
The low-frequency to high-frequency ratio (LF/HF ratio) is an index of cardiac sympathovagal balance. We hypothesized that insulin might also stimulate the LF/HF ratio. Thus, 15 lean and 15 obese subjects were studied...
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The low-frequency to high-frequency ratio (LF/HF ratio) is an index of cardiac sympathovagal balance. We hypothesized that insulin might also stimulate the LF/HF ratio. Thus, 15 lean and 15 obese subjects were studied. Each subject underwent sequential hyperinsulinemic clamps (insulin infusion rate 0.50, 1, and 2 mU/kg . min) while the heart rate was recorded by the Holter technique continuously. Indirect calorimetry allowed determination of the respiratory quotient (Rq) and substrate oxidation. The leg blood flow (LBF), leg vascular resistance (LVR), and plasma norepinephrine concentration were also measured. In seven lean subjects, hyperinsulinemic clamps were repeated along with propranolol infusion (0.1 mg . kg(-1) as an intravenous bolus dose followed by continuous intravenous infusion of 0.5 mg . kg(-1). min(-1) throughout the study). Lean subjects had better insulin action than obese subjects. Insulin infusion was associated with an increase of the Delta LF/HF ratio in both lean (P < .001 for time-dependent changes) and obese (P < .02 for time-dependent changes) subjects;however, the extent of insulin-mediated stimulation of the LF/HF ratio was greater in lean versus obese subjects. Insulin infusion did not significantly affect HF values in both groups. Independently of gender, body fat, changes in the plasma norepinephrine concentration, LBF, and LVR, the Delta LF/HF ratio at the end of the fastest insulin infusion (0.8 +/- 0.2 v 0.3 +/- 0.2, P < .04) was still greater in lean versus obese subjects. The Delta LF/HF ratio was also more stimulated during insulin versus insulin + propranolol infusion in lean subjects. In conclusion, insulin stimulates the LF/HF ratio in both lean and obese subjects and thus produces a shift in the cardiac autonomic nervous system activity toward sympathetic predominance. Copyright (C) 1999 by W.B. Saunders Company.
We prospectively studied the effects of cross-sex hormone administration on fat cell size and in vitro lipolytic activity in subcutaneous abdominal and gluteal fat biopsies obtained from 19 male-to-female (M-F) transs...
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We prospectively studied the effects of cross-sex hormone administration on fat cell size and in vitro lipolytic activity in subcutaneous abdominal and gluteal fat biopsies obtained from 19 male-to-female (M-F) transsexuals and 17 female-to-male (F-M) transsexuals. The amount of subcutaneous fat at the abdominal and gluteal levels was quantified with the use of magnetic resonance imaging (MRI). Before cross-sex hormone administration. M-F transsexuals had less subcutaneous fat with smaller fat cells compared with F-M transsexuals, with a higher baseline in vitro lipolytic activity expressed as glycerol release per milligram of triglyceride (TG) in the abdominal region (P < .05). Before cross-sex hormone treatment, no differences in lipolytic activity stimulated with arterenol (ART), isoproterenol (ISO), or ISO + insulin (INS) were observed between groups or regions. After a 1-year treatment with estrogens and antiandrogens in M-F transsexuals, subcutaneous fat areas on MRI and fat cell size were increased (P < .001) and reductions were observed in the basal lipolytic activity of gluteal and abdominal fat biopsies (P < .05). Following administration of testosterone to F-M transsexuals, subcutaneous fat and fat cell size at the gluteal and abdominal depots were decreased (P < .01) and basal lipolysis was increased significantly at the abdominal level (P < .05) but not at the gluteal level. In both M-F and F-M transsexuals, no effect of sex hormone administration was observed on stimulated lipolytic activities;In conclusion, regional sex differences in the amount of subcutaneous fat, adipocyte size, and in vitro basal lipolytic activity were demonstrated that could be largely reversed by cross-sex hormone treatment in adult subjects, providing evidence for their dependence on the sex steroid milieu. Copyright (C) 1999 by W.B. Saunders Company.
This liquid medication dispenser offers an easy, convenient means for accurate dispensing of medication. The ability of the device to store dose size, time to next dose, remaining available doses, and doses dispensed ...
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This liquid medication dispenser offers an easy, convenient means for accurate dispensing of medication. The ability of the device to store dose size, time to next dose, remaining available doses, and doses dispensed may allow for future analysis of patient behavior and improve compliance.
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