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Biomedical subjects

B A Kroner

Publications and source records attributed to B A Kroner.

9 recordsLinked to original sources
PubMed1998

Management of patients with type 2 diabetes by pharmacists in primary care clinics.

OBJECTIVE: To determine the impact of clinical pharmacists involved in direct patient care on the glycemic control of patients with type 2 diabetes mellitus. DESIGN: Eligible patients included those with type 2 diabetes who received insulin or were initiated on insulin therapy by the pharmacists and were willing to perform self-monitoring of blood glucose. The pharmacists provided diabetes education, medication counseling, monitoring, and insulin initiation and/or adjustments. All initial patient interactions with the pharmacists were face-to-face. Thereafter, patient-pharmacist interactions were either face-to-face or telephone contacts. SETTING: Two primary care clinics in a university-affiliated Veterans Affairs Medical Center. PARTICIPANTS: Study subjects were patients with type 2 diabetes who were referred to the pharmacists by their primary care providers for better glycemic control. OUTCOME MEASURES: Primary outcome variables were changes from baseline in glycosylated hemoglobin, fasting blood glucose, and random blood glucose measurements. Secondary outcomes were the number and severity of symptomatic episodes of hypoglycemia, and the number of emergency room visits or hospitalizations related to diabetes. Twenty-three veterans aged 65-9.4 years completed the study. Fifteen (65%) patients were initiated on insulin by the pharmacists; 8 (35%) were already using insulin. Patients were followed for a mean-SD of 27-10 weeks. Glycosylated hemoglobin, fasting blood glucose concentrations, and random blood glucose concentrations significantly decreased from baseline by 2.2% (p = 0.00004), 65 mg/dL (p < 0.01), and 82 mg/dL (p = 0.00001), respectively. Symptomatic hypoglycemic episodes occurred in 35% of patients. None of these episodes required physician intervention. CONCLUSIONS: This study demonstrates that pharmacists working as members of interdisciplinary primary care teams can positively impact glycemic control in patients with type 2 diabetes requiring insulin.

Aged↗
PubMed1998

Anticoagulation Clinic in the VA Pittsburgh Healthcare System.

This article describes the Anticoagulation Clinic (ACC) within the Veterans Administration Healthcare System. The clinic has been in operation for 10 years and has increased patient visits by 550 percent over this time period. Unlike many ACCs, inpatient anticoagulation management services have lagged behind outpatient services. The typical patient is an older white male who is prescribed warfarin for a cardiac condition (atrial fibrillation, mechanical heart valve replacement, congestive heart failure/cardiomyopathy). The VA system provides prescriptive authority and offers much latitude for patient management by ACC pharmacists. A comprehensive credentialing process has been developed, and quality improvement monitors show warfarin-related complications are comparable to other clinics and are less than routine medical care. In general, patients are satisfied with the care they receive and are comfortable with pharmacists monitoring and adjusting their warfarin therapy.

Anticoagulants↗
PubMed1997

Patient survey of a pharmacist-managed anticoagulation clinic.

The literature describing pharmacy involvement with anticoagulation services primarily does not include information about patients' perceptions of this involvement. A 22-question survey was developed and administered to 296 patients enrolled in the anticoagulation clinic at the VA Pittsburgh Health Care System. Excluded patients had fewer than four clinic visits or were followed outside of the anticoagulation clinic. The study period was nine weeks and any missed patients were telephoned. The median response to each question was determined. Similar questions were analyzed for acquiescent trends. Results indicate that, overall, patients are comfortable with pharmacists providing warfarin monitoring and dose adjustments.

Adult↗
PubMed1996

Potential interaction between warfarin and fluvastatin.

OBJECTIVE: To report three cases of a suspected interaction between warfarin and fluvastatin. CASE SUMMARIES: Three patients receiving stable warfarin dosages with therapeutic international normalized ratios (INRs) exhibited increased INRs when fluvastatin was added to their maintenance regimens. While none of the patients experienced a bleeding episode, they did require a reduction in their weekly warfarin dosage to achieve an appropriate level of anticoagulation. DISCUSSION: Reports of an interaction between warfarin and lovastatin have been described previously; however, to our knowledge, this is the first published report of a possible interaction between warfarin and fluvastatin. These cases were chosen because other factors that could potentially increase the INR were ruled out as significant contributors. CONCLUSIONS: The exact mechanism for the potential interaction between warfarin and fluvastatin is unknown. Until more is known, it is advisable to monitor patients more frequently when fluvastatin is initiated, discontinued, or adjusted in patients taking warfarin.

Aged↗
PubMed1995

Drug poisoning in older patients. Preventative and management strategies.

Children under 6 years of age are involved in the majority of poisonings. However, the elderly are more likely to require hospitalisation and to die from poisonings compared with younger individuals. Drugs play an important role in the poisoning exposures of older patients. Analgesics, cardiovascular medications, theophylline preparations and antidepressants and other psychotropic medications are most commonly implicated in drug poisoning fatalities in elderly Americans. Careful review of information which characterises drug poisonings in the elderly is essential to the development of effective preventative strategies. Most poison centre calls for elderly patients involve accidental exposures. The ingestion of extra doses of medications because of forgetfulness, mistaken identity of medications, incorrect route of administration, and improper storage of medications are among the the primary reasons for unintentional drug poisonings in older patients. A model for injury control composed of 3 phases can be applied to poison exposures in the elderly: activities in the pre-event phase focus on prevention; it should occur; the post-event phase is directed at appropriate management to reduce the consequence of injury from poison exposure once it occurs. The general management of drug poisonings is similar in older and younger patients. However, management in the elderly is complicated by difficulties in the diagnosis of drug poisoning, pharmacokinetic and pharmacodynamic changes associated with aging, increased incidence of chronic illness, and increased medication with the potential for clinically significant drug interactions. Aggressive initial treatment is imperative because the elderly are generally more susceptible to the toxic effects of drugs.

Aged↗
PubMed1993

Poisoning in the elderly: characterization of exposures reported to a poison control center.

OBJECTIVE: To determine the incidence of poison center calls involving the elderly, characterize these poisonings, and compare them with poisonings that occur in people younger than 60 years of age. DESIGN: Concurrent, observational survey. SETTING: The Virginia Poison Center in Richmond, Virginia. PARTICIPANTS: All persons 60 years of age and older who were involved in a poison exposure reported to the Virginia Poison Center from October 1, 1991 through March 31, 1992. MEASUREMENTS: Incidence, type, route, location, management site, medical outcome of exposures and reasons for these exposures. RESULTS: Exposures in persons 60 years of age and older accounted for 2.3% of all poison center calls during the 6-month study period. These calls were most likely to involve women who unintentionally ingested extra doses of medications. The majority of these exposures occurred in the home and resulted in either no effect or minor effects. For those exposures that necessitated an emergency room visit, elderly persons were more likely to be admitted to the hospital than younger persons (P < 0.05). CONCLUSIONS: The majority of poisonings that occur in persons 60 years of age and older are unintentional and may be amenable to poison prevention education.

Age Factors↗
PubMed1993

Effect of frequently prescribed cardiovascular medications on sexual function: a pilot study.

OBJECTIVE: To determine the effect on male sexual function of initiating any one of the cardiovascular medications most frequently prescribed at our institution. DESIGN: Men were surveyed via telephone when they received a new prescription for hydrochlorothiazide, furosemide, lisinopril, verapamil, nifedipine, or diltiazem, and after 30 days of daily medication ingestion. To assess Hawthorne effect, men who had no change to their medication regimen also were surveyed at the time of medication refill for maintenance therapy and 30 days later. PARTICIPANTS: Community-dwelling male veterans who received a single new prescription between January 1 and April 1, 1992 (n = 134). MAIN OUTCOME MEASURES: Responses to questions about sexual interest, erectile function, orgasmic ability, and sexual satisfaction. RESULTS: Men who had no change to their medication regimen showed no change in sexual interest, erectile function, orgasmic ability, or satisfaction. Hydrochlorothiazide was associated with decreased orgasmic ability (p = 0.008). Although none of the other changes were statistically significant (p < 0.05), both nifedipine and diltiazem showed a trend toward improved sexual function. CONCLUSIONS: Hydrochlorothiazide may be associated with anorgasmia. More study is needed to determine if nifedipine and diltiazem improve erectile function. Furosemide, lisinopril, and verapamil likely have no effect on sexual function.

Cardiovascular Agents↗