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Biomedical subjects

C D Butler

Publications and source records attributed to C D Butler.

At least 19 recordsLinked to original sources
PubMed1994

Evaluation of ondansetron prescribing in US academic medical centers.

BACKGROUND: The study objectives were to characterize the use of the antiemetic ondansetron, a serotonin subtype 3 receptor antagonist, in US academic medical centers, and to assess ondansetron prescribing with consensus-derived prescribing guidelines used as evaluation criteria. METHODS: A multicenter, prospective, observational study was conducted in the inpatient and outpatient care areas of 23 US academic medical centers. A total of 670 patients received ondansetron (508 inpatients and 162 outpatients). The use of ondansetron was compared with consensus-derived prescribing guidelines on the basis of indication for use and dose administered. RESULTS: Only 253 (37.8%) of the 670 patients satisfied for prescribing guidelines for both indication for use and dose administered. The remainder of the patients did not satisfy the guidelines, in whole or in part. If all ondansetron use had met the prescribing guidelines in the patients studied, a reduction in ondansetron use of 31% (16 185/52 260 mg) would have been realized. At an estimated cost of $5 per milligram, this reduction represents a potential cost savings of nearly $81,000, or $121 per patient studied. CONCLUSION: Since its introduction in 1991, ondansetron has become a commonly used antiemetic in US academic medical centers. Although ondansetron is safe and effective in improving patients' tolerance of emetogenic therapies, including cancer chemotherapy, its high cost has added a significant burden to the pharmaceutical budgets of many institutions. The study data suggest that compliance with ondansetron prescribing guidelines, with elimination of indiscriminant use, could result in significant cost savings.

Academic Medical Centers↗
PubMed1993

Evaluation of physician decision making with the use of prior probabilities and a decision-analysis model.

OBJECTIVES: To determine whether treatment decisions could be influenced by supplying probabilities and whether these decisions would be consistent with a decision-analysis model. DESIGN: Survey with case scenarios and a computerized decision-analysis model. SETTING: Family practice residency program. PARTICIPANTS: Forty family practice residents and faculty in the experimental group and six controls. INTERVENTIONS: Twelve cases scenarios of patients with hypertension and coexisting diseases were developed. Family practice physicians were asked to rank their drugs of choice for each case. In the second phase, six case scenarios included probabilities for efficacy and adverse reactions of step 1 antihypertensives. These drug selections were compared with a computerized decision-analysis model. MAIN OUTCOME MEASURES: Frequencies of matches between the drug selections of physicians and the computer model. RESULTS: The frequency of matches before probabilities were provided to physicians was low (45.6%) and there was a significant increase when probabilities were supplied (71.3%). Regardless of experience level, physicians increased their consistency with the computer model after probabilities were supplied. CONCLUSIONS: This study demonstrated that physician decision making for antihypertensive therapy can be influenced by patient-specific probability estimates. Probability data can help less experienced residents make decisions that are comparable to those of attending physicians. This study was conducted in one residency program and the generalizability to the practicing physician is unknown. These findings would suggest that educational efforts in residency programs, health maintenance organizations, or group practices may benefit from patient-specific probabilities that assist with decisions for drug therapy interventions.

Adult↗
PubMed1992

Decision analysis as a quality-assurance screening tool.

BACKGROUND: The purpose of this pilot study was to examine whether the technique of decision analysis, including sensitivity analysis, could be used in a clinical quality-assurance program. METHODS: This research was performed in a family practice residency clinical practice. A computerized decision analysis model was developed for selection of initial drug therapy for hypertension. The medical records of 52 resident-managed patients with hypertension were then reviewed. The residents' drug prescribing was evaluated by faculty reviewers and also by the decision analysis model, including a sensitivity analysis. RESULTS: Faculty reviewers rated the residents' drug choices as "most appropriate" or "acceptable" in 59.6% of cases. There was good agreement between faculty reviewers and the computerized decision analysis model. For example, in those cases in which the resident chose the computer model's first-choice drug, faculty deemed the management as "most appropriate" or "acceptable" 93.3% of the time. When residents selected the computer model's third or fourth choice, faculty judged the residents' therapy as "inappropriate" or "an alternate drug would have been more desirable" in 61.9% of cases. CONCLUSION: The results suggest that computerized decision analysis techniques may be a useful adjunct to other clinical quality-assurance procedures in residency training programs.

Adult↗
PubMed1991

A model of lifetime osteoporosis impact.

The study goal was to use population-based data to model aspects of lifetime osteoporosis impact not previously studied, specifically: (1) to estimate person-years of fracture-related functional impairment against the trajectory of functional status in the general population; (2) jointly to consider hip, vertebral, and Colles' fractures in estimating the percent of women who will ever fracture; and (3) to estimate the lifetime number of fractures expected in a cohort of 10,000 50-year-old white postmenopausal women. The model estimates that 54% of 50-year-old women will sustain osteoporosis-related fractures during their remaining lifetimes. Beyond the functional impairment expected in similarly aged, unfractured women, osteoporosis-related fractures are estimated to cause 6.7% of women to become dependent in basic activities of daily living; 7.8% are expected to require nursing home care for an average of 7.6 years.

Cohort Studies↗
PubMed1986

The p97 antigen is mapped to the q24-qter region of chromosome 3; the same region as the transferrin receptor.

Since the p97 antigen, a membrane-associated iron-binding protein, has extensive amino acid sequence with homology with transferrin, is functionally related to the transferrin receptor, and has been previously mapped to chromosome 3, we have performed additional studies for regional mapping of the gene expressing p97 antigen. In these experiments, Chinese hamster-human cell lines were chosen that contained a large spectrum of autosomal human chromosomes, but mainly consisted of clones expressing all or a part of chromosome 3. These cell lines included a clone that previously allowed for mapping of human transferrin receptor to q22-qter region. Human p97 expression was assessed by specific binding of [125I]monoclonal antibody 96.5, and human transferrin receptor expression was tested by specific [125I]human transferrin binding and [125I]monoclonal antibody OKT-9 specific for human transferrin receptor. Based on these analyses, both human p97 antigenic expression and human transferrin receptor are mapped concordantly to the q24-qter region. These data and previous reports, therefore, suggest that the related iron-transport proteins are closely linked and may be under coordinate regulation. However, studies of several cell lines that exhibit up-regulation of human transferrin receptor expression with cellular proliferation, and down-regulation of receptor with increased transferrin-iron in the media, showed no change in expression of p97 antigen. p97 antigenic expression increased when melanocyte-stimulating hormone was added to a human melanoma cell line in tissue culture. These latter studies suggest that in mammalian cells the two proteins do not show coordinate regulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1983

Lidocaine stability in cardioplegic solution stored in glass bottles and polyvinyl chloride bags.

The stability of lidocaine hydrochloride in buffered cardioplegic solutions stored in glass and polyvinyl chloride bags was studied. Concentrations of lidocaine (incorporated as the hydrochloride salt) were measured in buffered cardioplegic solutions containing potassium chloride, sodium bicarbonate, dextrose, and sodium chloride. Solutions were stored at 22 +/- 2 degrees C and 4 degrees C in glass bottles and 500-ml and 250-ml polyvinyl chloride (PVC) containers; some 250-ml PVC bags were underfilled to study the effects of varying surface area-volume ratios. Lidocaine concentrations were measured using a homogeneous enzyme immunoassay (EMIT, Syva Corporation) on days 0, 1, 2, 7, and 21. Lidocaine concentrations decreased significantly in all PVC bags stored at 22 degrees C and in underfilled PVC bags stored at 4 degrees C. Lidocaine loss in PVC bags appeared to result from sorption. It is concluded that lidocaine is stable in cardioplegic solutions when these are refrigerated and stored in glass containers or filled large-volume PVC bags for 21 days.

Drug Combinations↗
PubMedDate not supplied

The consumption bomb.

The explosion of the population bomb has long been predicted to cause massive famine in overpopulated countries. Rising consumption, even in a time of decreasing population growth rates, now threatens adverse global health effects more severe than localised famines. The world faces potential ecological entrapment. This has two dimensions: planetary eco-impoverisation and planetary eco-pathology. Eco-impoverisation, the depletion of natural capital, arises as the limit of the global human carrying capacity approaches. Eco-pathology, the disruption of ecological support systems, arises because of the way the biosphere has been modified by human activity and is caused particularly by unsustainable consumption for human purposes. Despite encroaching ecological entrapment, the dominant economic paradigm claims record levels of growth; a paradox that needs recognition. Reasons for denial of the gravity of ecological entrapment are discussed. Ways are suggested to defuse the consumption bomb and avert ecological entrapment.

Conservation of Natural Resources↗