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A Steenhoek

Publications and source records attributed to A Steenhoek.

8 recordsLinked to original sources
PubMed1990

Prophylactic antibiotics and the hospital budget: controversy for patients and hospital financial strategies?

Although total drug costs account for only 2 to 3% of the total hospital budget, the management of these costs is of much interest. Total costs can be subdivided into numerous items; each can be influenced to some extent. Such costs are analysed in this article. The Dutch system of hospital budgeting is also described. The way in which (prophylactic) antibiotics can influence budget parameters is described and quantified by an example in gynaecological surgery. It is concluded that the profits of modern pharmacotherapy in the hospitals are earned outside the hospital. Society should realize that these profits must be re-invested to assure a healthy health-care system in the near future.

Anti-Bacterial Agents↗
PubMed1990

[Inventory and comparison of guidelines for antibiotic utilization in Dutch hospitals].

In 1976 the Dutch Health Council advised hospitals to formulate guidelines for use of antibiotics. These guidelines and their use should improve the quality of care in terms of medical effectiveness and cost-effectiveness. In 1988 the Peer Review Council held a survey among all (140) Dutch hospitals to collect data about these guidelines. Thirty-seven sets of guidelines used in 71 hospitals were obtained. We analysed these sets of guidelines as to the following general aspects: the status of the guidelines in the hospitals, the problem-oriented approach, the topics dealt with in the guidelines and the authors of the guidelines. Four specific aspects related to rational use of antibiotics were analysed as well: the use of cephalosporin, the use of different antibiotics for prophylaxis and therapy and the cost-effectiveness of antibiotic treatment in relation to urosepsis. Results of these analyses show that guidelines are too often formulated in a noncommittal way and that there is a need for a more functional registration system to link information about the clinical working diagnoses, the bacteria isolated and the sensitivity to the antibiotics used. These linkages are essential for feedback to clinicians, microbiologists and pharmacists and a prerequisite for management of the quality of care with respect to use of antibiotics.

Anti-Bacterial Agents↗
PubMed1988

Pharmacokinetics of methotrexate in continuous ambulatory peritoneal dialysis.

The pharmacokinetics of methotrexate and its 7-hydroxy metabolite were studied in a patient undergoing continuous ambulatory peritoneal dialysis. A biphasic plasma-disappearance pattern of methotrexate was observed, with half-lives of 3.5 and 29 hours. The 7-hydroxy metabolite accumulated and showed a very slow rate of elimination, with an estimated final elimination half-life of over 120 hours. The mean peritoneal clearance rate of methotrexate was 0.13 l/h (range 0.05-0.20 l/h), dwell times significantly influenced the clearance rate. Strict monitoring of the methotrexate level, even after low doses, is necessary in continuous ambulatory peritoneal dialysis patients, to prevent serious bone marrow toxicity.

Adult↗
PubMed1988

Clinical pharmacokinetics of midazolam in intensive care patients, a wide interpatient variability?

The pharmacokinetics of midazolam and its metabolites were studied in 17 patients on mechanical ventilation in a general intensive care unit who were receiving a continuous intravenous infusion of midazolam, adjusted according to the level of induced sedation. Three patients were studied twice. Serum midazolam and alpha-hydroxymidazolamglucuronide levels were determined during and after infusion. The sedation level was scored on a four-point scale. Half of the observed patients were still drowsy or asleep 10 hours after termination of midazolam infusion. In only one patient was midazolam serum elimination half-life less than 2 hours and in six patients the half-life was greater than 10 hours. A wide range of midazolam serum levels was associated with adequate sedation, and similarly the midazolam levels at the moment of awakening were highly variable. The serum concentration ratio of midazolam/alpha-hydroxymidazolamglucuronide at the end of the infusion varied from 0.03 to 15.6. Renal function could account for only a part of this variation.

Adult↗
PubMed1984

Sustained-release theophylline preparations. A comparative survey of 467 patients.

The comparative efficacy and patient compliance with treatment using three sustained-release theophylline preparations currently available in The Netherlands were evaluated by measuring the plasma concentration achieved in a survey of 282 hospital and 185 out-patients. Compliance was dramatically better amongst in-patients than those attending out-patient clinics. Complete treatment avoidance was higher than expected. Compliance was better among non-smokers than among patients who were still smoking. Patients clearly preferred preparations which permitted a simple daily dosing schedule requiring the minimum number of tablets. On this basis and that of the parameters measured, Theolair Retard was the preparation of choice. Plasma concentration should be monitored during long-term theophylline treatment.

Asthma↗
PubMed1980

[Interferon].

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Antineoplastic Agents↗