Clinical pharmacists in this study hospital reported 1027 interventions in patient drug therapy over two time periods of three and two weeks, respectively. These interventions were subjected to self and peer reviews and to cost-avoidance evaluation. The most frequent type of intervention was recommendations related to drug selection (29.6 percent). Recommendations were not implemented by physicians in only 10.2 percent of the cases. The perceived impact of these interventions on the quality, cost, or both was found by the peer reviewers to occur in 58.5, 16.1, and 25.6 percent of the cases, respectively. Also, when peer reviewed for clinical significance, 983 of these interventions were judged to improve drug therapy to an acceptable level based on the professional literature, and 36 were deemed very significant in terms of saving patients' lives or preserving major organ functions. Of the 983 interventions rendering drug therapy to an appropriate level, 398 were deemed to have cost-avoidance impact; of this number a 25 percent random sample was subjected to cost-avoidance evaluation. Realized cost-avoidance averaged $242 for each intervention implemented. When extrapolated annually, $364 900 was the net realized cost-avoidance after discounting for the cost of providing clinical pharmacy services. An average cost-avoidance of $860.50 was calculated for each intervention made by pharmacists, but not followed by physicians, for an annual potential cost-avoidance of $532 650. In all, clinical pharmacists had the potential to save $897 550 annually in hospital resources if all their interventions had been accepted and implemented.

The primary objectives of the article were accomplished by providing both a bibliography of articles dealing with clinical pharmacy services in acute-care facilities and summaries of those constituting original research reports on clinical pharmacy services. However, in the process, we made the following interesting observations. We found that articles reporting impacts on cost, quality, and attitude numbered 48, 58, and 24, respectively. Most articles relating to drug therapy monitoring, with minor exceptions, dealt with either the quality or cost-savings impact or a combination of both. Also, articles concerning drug therapy monitoring comprised almost half of all those summarized (40 articles). Articles detailing drug information and education (category 2) numbered 28 and dealt mainly with attitudes or quality impacts with minor reference to cost-savings. It was also interesting, albeit expected, to observe that the bulk of attitudinal studies fell in category 2. We found category 5, controlling medication administration, had 13 articles, primarily concerned with cost and or quality. Category 4, reporting and detection of adverse drug reactions, contained a total of eight articles mainly studying the impact on quality. The other categories contained very few, if any, articles. From these results, it is evident that the profession has made significant strides in building a strong scientific data base to support the value of its clinical services. However, there is ample room for additional original research reports. Although it can be argued that alone many of the studies could not justify clinical pharmacy as cost-effective, organized as one reference they provide an invaluable resource. Although it might be unreasonable to expect each pharmacy department to be able to cost-justify its existence, this work presents the background data needed to begin or develop such efforts.

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Infection and infection-related complications are important causes of death and morbidity following preterm birth. Despite this, there is limited understanding of the development of the immune system in those born prematurely and how it is influenced by perinatal factors. To investigate this, we prospectively and longitudinally followed a cohort of babies born before 32 weeks of gestation. We demonstrated that preterm babies, including those born extremely prematurely, were capable of rapidly acquiring adult levels of immune functionality; that immune maturation appeared to occur independently of the developing microbiome, which was highly heterogeneous across different infants; and that the biggest drivers of change in the trajectory of perinatal immune development was exposure to infection in utero or postnatally. Conspicuously, a unifying factor among infants who developed infection despite their growing immune potentials was an inability to mount adequate T cell CXCL8 responses. Because this defect was present at birth, it may predict those babies likely to have poor clinical outcomes. . Babies born between 23 weeks and 4 days and 31 weeks and 6 days of gestation admitted to the NICU before 72 hours' postnatal age, including those born at other hospitals, were included in this study. Infants with a probable lethal congenital abnormality, thought to have no realistic chance of survival, or with known exposure to either HIV or hepatitis B infection were excluded.Written informed consent was obtained from parents before 72 hours of age. Sample collection and storageBlood samples (0.5 ml whole blood) were collected on a weekly basis, with additional samples taken at times of suspected infection, up to cessation of the subjects' participation. These were stored at room temperature (on average for 12 hrs and up to a maximum of 30 hrs) prior to Ficoll separation of PBMCs, and were frozen in Cryostore (Sigma) and stored in liquid nitrogen. Faecal samples were collected on a daily basis (when available) from birth up to cessation of the subjects' participation in the study (i.e. discharge or transfer). Samples were immediately stored at 4°C for <72hrs, before transferral to long-term storage at -80C. Clinical dataDetailed demographic, antenatal and daily postnatal data were collected prospectively. Once each subject completed their hospital stay, their clinical course was reviewed by the clinical team and the subjects classified a priori into one three clinical cohorts: