PURPOSE: Clinical decision support systems (CDSS) are promoted as powerful screening tools to improve pharmacotherapy. The aim of our study was to evaluate the potential contribution of CDSS to patient management in clinical practice. METHODS: We prospectively analyzed the pharmacotherapy of 100 medical inpatients through the parallel use of three CDSS, namely, Pharmavista, DrugReax, and TheraOpt. After expert discussion that also considered all patient-specific clinical information, we selected apparently relevant alerts, issued suitable recommendations to physicians, and recorded subsequent prescription changes. RESULTS: For 100 patients with a median of eight concomitant drugs, Pharmavista, DrugReax, and TheraOpt generated a total of 53, 362, and 328 interaction alerts, respectively. Among those we identified and forwarded 33 clinically relevant alerts to the attending physician, resulting in 19 prescription changes. Four adverse drug events were associated with interactions. The proportion of clinically relevant alerts among all alerts (positive predictive value) was 5.7, 8.0, and 7.6%, and the sensitivity to detect all 33 relevant alerts was 9.1, 87.9, and 75.8% for Pharmavista, DrugReax and TheraOpt, respectively. TheraOpt recommended 31 dose adjustments, of which we considered 11 to be relevant; three of these were followed by dose reductions. CONCLUSIONS: CDSS are valuable screening tools for medication errors, but only a small fraction of their alerts appear relevant in individual patients. In order to avoid overalerting CDSS should use patient-specific information and management-oriented classifications. Comprehensive information should be displayed on-demand, whereas a limited number of computer-triggered alerts that have management implications in the majority of affected patients should be based on locally customized and supported algorithms. Methods We prospectively analyzed the pharmacotherapy of 100 medical inpatients through the parallel use of the CDSS Pharmavista, DrugReax and TheraOpt. After expert discussion that also considered all patient-specific clinical information we selected apparently relevant alerts, issued according recommendations to physicians and recorded subsequent prescription changes.Results For 100 patients with a median of eight concomitant drugs Pharmavista, DrugReax and TheraOpt generated a total of 53, 362 and 328 interaction alerts, respectively. Among those we identified and forwarded 33 clinically relevant alerts that were followed by 19 according prescription changes. Four adverse drug events were associated with interactions.The proportion of clinically relevant alerts among all alerts (positive predictive value) was 5.7, 8.0 and 7.6%, and the sensitivity to detect all 33 relevant alerts 9.1, 87.9 and 75.8% for Pharmavista, DrugReax and TheraOpt, respectively. TheraOpt recommended 31 dose adjustments, of which we considered 11 as relevant, and three were followed by dose reductions.Conclusions CDSS are valuable screening tools for medication errors, but on...

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RESUMO: "Efeito inibitório de extratos de Hypericum myrianthum e H. polyanthemum sobre a germinação e crescimento de Lactuca sativa L". Neste trabalho foi investigado o efeito inibitório de extratos etanólicos de partes aéreas de Hypericum myrianthum e Hypericum polyanthemum sobre a germinação e o crescimento de alface (Lactuca sativa). A germinação das sementes foi reduzida em todas as concentrações avaliadas. Após sete dias, o percentual de germinação foi signifi cativamente retardado pelos extratos de ambas as plantas, nas maiores concentrações, em comparação com o grupo controle. O comprimento das radículas foi signifi cativamente afetado, estas apresentando alguns sinais de necrose. As duas espécies apresentam compostos fenólicos como constituintes principais, os quais podem ser responsáveis pela inibição da germinação e crescimento de Lactuca sativa. Unitermos:Hypericum myrianthum, Hypericum polyanthemum, Lactuca sativa, atividade alelopática, radícula, germinação de sementes.ABSTRACT: Germination and growth inhibitory effects of ethanolic crude extracts of Hypericum myrianthum and H. polyanthemum aerial parts on lettuce (Lactuca sativa) were investigated. The germination was retarded in all the tested concentrations. After seven days the fi nal germination percentage of the most concentrated extracts was signifi cantly reduced by both extracts in comparison with the control. The radicles length was signifi cantly affected showing necrosis. Both species present phenolic compounds as the main components and they could be responsible for the inhibition of the germination and growth of Lactuca sativa.

BackgroundThe development of novel influenza vaccines inducing a broad immune response is an important objective. The aim of this study was to evaluate live vaccines which induce both strong humoral and cell-mediated immune responses against the novel human pandemic H1N1 influenza virus, and to show protection in a lethal animal challenge model.Methodology/Principal FindingsFor this purpose, the hemagglutinin (HA) and neuraminidase (NA) genes of the influenza A/California/07/2009 (H1N1) strain (CA/07) were inserted into the replication-deficient modified vaccinia Ankara (MVA) virus - a safe poxviral live vector – resulting in MVA-H1-Ca and MVA-N1-Ca vectors. These live vaccines, together with an inactivated whole virus vaccine, were assessed in a lung infection model using immune competent Balb/c mice, and in a lethal challenge model using severe combined immunodeficient (SCID) mice after passive serum transfer from immunized mice. Balb/c mice vaccinated with the MVA-H1-Ca virus or the inactivated vaccine were fully protected from lung infection after challenge with the influenza H1N1 wild-type strain, while the neuraminidase virus MVA-N1-Ca induced only partial protection. The live vaccines were already protective after a single dose and induced substantial amounts of neutralizing antibodies and of interferon-γ-secreting (IFN-γ) CD4- and CD8 T-cells in lungs and spleens. In the lungs, a rapid increase of HA-specific CD4- and CD8 T cells was observed in vaccinated mice shortly after challenge with influenza swine flu virus, which probably contributes to the strong inhibition of pulmonary viral replication observed. In addition, passive transfer of antisera raised in MVA-H1-Ca vaccinated immune-competent mice protected SCID mice from lethal challenge with the CA/07 wild-type virus.Conclusions/SignificanceThe non-replicating MVA-based H1N1 live vaccines induce a broad protective immune response and are promising vaccine candidates for pandemic influenza.

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