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Biomedical subjects

C E Daniels

Publications and source records attributed to C E Daniels.

16 recordsLinked to original sources
PubMed1990

Impact of a drug-use review program intervention on prescribing after publication of a randomized clinical trial.

The effect of a drug-use review (DUR) program intervention on physician prescribing after the results of a randomized clinical trial were published was studied. A Veterans Administration (VA) cooperative study published in June 1986 showed that congestive heart failure (CHF) patients who had hydralazine and isosorbide added to their drug therapy had less mortality than patients given digoxin and diuretics with or without prazosin. Physicians with at least one CHF patient who was receiving the less effective therapy were randomly assigned to intervention and control groups. In September 1986, intervention-group physicians (n = 288) were mailed a letter and questionnaire from the DUR program coordinator, the journal article, and a drug history profile of a CHF patient who might benefit from the information. Control physicians received no mailing. The questionnaire asked whether the physicians already knew about the VA study, intended to alter their prescribing, and could identify factors that would affect their decision. Two thirds of intervention-group physicians were already aware of the VA study. One third indicated that they intended to alter drug therapy based on the study results; factors significantly associated with the intent to adopt a change were physician training and experience, comments by peers, new drug availability, and the size of the reduction in mortality. During four months after the intervention, only 5 physicians in the two groups switched their patients to both hydralazine and isosorbide (full change); 23 switched them to at least one of the drugs or discontinued prazosin (partial change). There was no significant difference in the number of full or partial changes between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1989

Indicators for the selection of ambulatory patients who warrant pharmacist monitoring.

The development of indicators to identify ambulatory patients who might benefit from pharmacist monitoring is described. With the assistance of an eight-member panel of ambulatory-care pharmacists, six prognostic indicators were identified: (1) five or more medications in present drug regimen, (2) 12 or more medication doses per day, (3) medication regimen changed four or more times during the past 12 months, (4) more than three concurrent disease states present, (5) history of noncompliance, and (6) presence of drugs that require therapeutic drug monitoring. The charts of patients who had visited the internal medicine, general surgery, pediatric, and obstetric/gynecology clinics during five randomly selected weeks in 1985 and 1986 were reviewed to determine the presence or absence of the six prognostic indicators and their adverse outcomes. Evidence of drug-therapy-related adverse outcomes was present in 79 (33.1%) of 239 charts. Charts of patients with a documented history of noncompliance were most likely to show evidence of an adverse outcome. The likelihood that a patient chart would show evidence of an adverse outcome increased as the number of prognostic indicators present increased. The presence of individual or multiple prognostic indicators in the charts of ambulatory-care patients should enable pharmacists to identify patients at greatest risk of experiencing drug-therapy-related adverse outcomes.

Ambulatory Care↗
PubMed1988

Substitution of skimmed milk for high-fat milk in the diets of men and women in South Wales.

The potential for achieving the NACNE target for percentage of energy derived from fat (34 per cent), resulting from the theoretical substitution of skimmed milk for high-fat milks, was investigated using the dietary records of 738 middle-aged males and females in the South Wales area. The average male in the sample could theoretically achieve the NACNE target by changing to skimmed milk providing that energy intake remained the same. In the small sample of women the average female could not reach the NACNE target. Four groups of individuals were identified: -(1) Those consuming diets providing less than 34 per cent of total energy from fat; (2) those unable to reach the NACNE target by changing to skimmed milk; (3) those who could reach the NACNE target by changing to skimmed milk even if they remained in energy deficit; (4) those who could reach the NACNE target by changing to skimmed milk providing that they made up the lost energy by eating foods free of fat. A graph is presented which would enable a trained person to assess whether substitution of skimmed for high-fat milks would result in an individual achieving the NACNE recommendation.

Animals↗
PubMed1988

Evaluation of five systems to determine technician staffing in a unit dose cart-filling area.

The development and evaluation of predictive systems to determine staffing needs in a centralized unit dose cart-filling area were studied. Data concerning actual cart-filling time and the hospital's daily census, by total beds and by bed type, were collected over 55 days. Four predictive systems were then developed, as follows: simple average, range average, simple regression, and multiple regression. In addition to these mathematical systems, a pharmacist "best-guess" system was devised, whereby the pharmacist directing the cart-filling area estimated the staffing needs on a daily basis during the trial period. The five systems were then used to predict cart-filling time daily over 14 days. During this time, the actual filling time was recorded and compared with the times predicted by the five systems. The differences among the actual or predicted mean cart-filling times for the five systems were not significant. The pharmacist best-guess system was on average the most accurate in detecting different staffing needs; the advantage of this system is that the pharmacist can evaluate differences in work habits among the scheduled technicians, which the mathematical models would be unable to do. The simple average system correlated well with changes in filling time and most precisely predicted variability in census. Although none of the systems was superior in all respects, a combination of the pharmacist best-guess and simple-average systems appeared to be the best method for predicting daily technician staffing needs in the central cart-filling area.

Data Collection↗
PubMed1986

Personnel costs and preparation time in a centralized intravenous admixture program.

The amount of time and the cost of personnel time associated with the preparation of injectable products were determined. A time study consisting of 9041 observations during a seven-day period was conducted to determine the amount of time required of pharmacists and technicians for the preparation of total parenteral nutrient (TPN) solutions, large-volume injectables, antibiotic admixtures, antineoplastic admixtures, and investigational drugs. The established times were used to calculate relative value units for each product line and to determine the cost of pharmacist and technician time associated with the preparation of each product line. Preparation times ranged from 3.7 minutes for an antibiotic admixture to 49 minutes for a pediatric TPN solution. Total personnel costs ranged from $0.71 for an antibiotic admixture to $10.70 for a pediatric TPN solution. The calculated relative value units indicated that existing departmental time standards did not allow sufficient time for the preparation of some products. Establishing relative value units and calculating the cost of personnel time associated with the preparation of injectable products can be helpful for comparing the cost of purchasing ready-to-use products with the cost of preparing the same products.

Costs and Cost Analysis↗
PubMed1986

Patient acuity indicators as predictors of pharmacy workload.

The feasibility of using two workload indicators from a nursing patient-classification system as a means of predicting pharmacy workload was studied. Frequency data for 13 pharmacy distribution and clinical activities were recorded daily for 28 consecutive days and compared with daily data for acuity of patient illness and number of standard hours of nursing care required on nine nursing units. The strength of the associations between (1) pharmacy workload and patient acuity and (2) pharmacy workload and standard hours of nursing care was determined by linear regression analysis. Both same-day and one-day-lagged analyses were performed; the one-day-lagged analyses looked at pharmacy workload on a given day in relation to nursing workload on the previous day. A total of 252 observations were available for analysis. Pharmacy workload and same-day standard hours of nursing care were correlated most strongly, although all of the analyses yielded large coefficients of correlation. Analysis of data from individual nursing stations yielded smaller coefficients of correlation, especially for the one-day-lagged analyses. At least 73% of the variance in pharmacy workload could be attributed to variance in nursing workload. The index of patient acuity of illness and the number of standard hours of nursing care are good predictors of pharmacy workload of the same and the following days; the potential exists to use these nursing workload indicators in determining pharmacy staffing requirements.

Minnesota↗
PubMed1985

Aspiration of blood from the jugular vein during intracarotid drug infusion in monkeys. Implications for extracorporeal drug removal.

Circulation of blood in the ipsilateral jugular vein through an extracorporeal circuit for drug removal during intracarotid chemotherapy has recently been reported to decrease the systemic drug exposure. The reduced systemic exposure achieved by the use of this technique should permit a several-fold increase of the intracarotid dose of chemotherapy without increasing systemic toxicity. To determine the influence of the rate of blood removal from the jugular vein on the fraction of the blood flowing through the ipsilateral internal carotid artery (ICA) collected for extracorporeal drug removal, the authors aspirated blood from the jugular bulb into an extracorporeal circuit at varying rates during a constant infusion of the indicator dye, indocyanine green (ICG), into the ICA of rhesus monkeys. The fraction of the ipsilateral carotid blood channeled into the extracorporeal circuit increased linearly with the rate of aspiration of jugular blood. This suggests that the absence of valves in the intracranial venous system should permit increasing fractions of drug removal during intracarotid infusion by increasing the rate of collection of venous blood from the ipsilateral jugular bulb. The measurement of ICG concentrations in a similar manner in patients undergoing isolated perfusion may prove to be a clinically useful method for estimating the maximum safe dose in high-dose intra-arterial chemotherapy.

Animals↗
PubMed1985

Managing the inventory control system.

The four functions of management--planning, organizing, directing, and controlling--are described in relation to the hospital pharmacy inventory control system. Planning includes the development of inventory system objectives and identification of the resources needed to complete them. Organizing requires the manager to decide on the best method of grouping system activities and resources to complete the objectives in order of priority. Directing is a continual activity that involves obtaining optimal performance from the inventory system resources available. Controlling consists of regulation and verification of inventory system activities. The effective inventory system manager integrates planning, organizing, directing, and controlling in a continuous cycle.

Costs and Cost Analysis↗
PubMed1984

Antibiotic preparation time in a horizontal laminar-airflow hood and in a biological-safety cabinet.

Times for preparation of injectable antibiotics in syringes and minibags were compared using a horizontal laminar-airflow hood (HLAH) and a Class II biological-safety cabinet (BSC). Six i.v. admixture technicians who had previous experience with both types of hoods were observed during batch preparation of tobramycin, clindamycin, and cefamandole in syringes and tobramycin, clindamycin, and acyclovir in minibags. Before timing began, the drug products were reconstituted and labels were prepared. Mean times for syringes were 60.4 seconds (n = 267) for the HLAH and 65.9 seconds (n = 186) for the BSC (p greater than 0.05). For minibag doses, mean times were 64.9 seconds (n = 129) for the HLAH and 78.3 seconds (n = 126) for the BSC (p greater than 0.05). Technicians' times for aseptic preparation of injectable antibiotics in syringes and minibags were not significantly greater when the procedures were performed in a biological-safety cabinet than when a horizontal laminar-airflow hood was used.

Anti-Bacterial Agents↗
PubMed1983

Economies of purchasing group size.

The relationship of drug price and purchasing group size was evaluated. Thirty drug line items were studied in 26 private hospital purchasing groups of various sizes. Prices were analyzed relative to purchasing group size, age, and location. Drug prices were negatively correlated to group size in a linear relationship. Prices were significantly lower in groups representing greater than 10,000 beds. No significant relationship was found between group age or location and drug prices. The theory that increasing purchasing group size will result in better contract prices was supported.

Hospital Shared Services↗
PubMed1983

Work-sampling evaluation of an upgraded outpatient pharmacy computer system.

The effect of an upgraded outpatient pharmacy computer system on routine dispensing activities was studied. A computer system that previously generated patient bills, prescription labels, and management reports was upgraded to provide patient profiles, allergy and drug-drug interaction monitoring, auxiliary-label notification, and prescription prices. Four months after the upgraded system was implemented, dispensing activities were analyzed using a work-sampling technique. The percent of time spent in prescription processing, inventory maintenance, problem solving, or miscellaneous activities was determined. These data were compared with data obtained in a study of the old system. A total of 5897 observations of the upgraded system was compared with 5632 observations in the previous study. There were significantly different changes among the four activity groups for the total staff and for pharmacists, technicians, and the data-entry operator. Under the modified system, pharmacists spent more time in prescription coding and less time on patient counseling. The data-entry operator had less computer-entry time. It could not be stated conclusively that overall efficiency was improved by the new system.

Computers↗
PubMedDate not supplied

Increased dosage requirements of tobramycin and gentamicin for treating Pseudomonas pneumonia in patients with cystic fibrosis.

The pharmacokinetic behavior of tobramycin and gentamicin was evaluated in 27 patients who had cystic fibrosis (CF). A previously studied, age-matched group of 334 patients who had been treated with gentamicin and who did not have CF served as controls. The CF patients, who ranged in age from 2 to 32 years and who had normal renal function, received 36 treatment courses with either tobramycin (19) or gentamicin (17) to treat Pseudomonas pneumonia. Serum concentrations were determined after a 1.5-mg/kg dose to compute half-life (t 1/2), elimination rate constant (k), and apparent volume of distribution (V). From these values, doses were calculated to produce steady-state peak concentrations of 8.0 micrograms/ml with a dosing interval of every six hours. For tobramycin the mean (+/- SD) t1/2 was 1.0 (0.4) hours, V was 0.18 (0.06) l/kg, total body clearance (TBC) was 2.19 (0.71) ml/min/kg, and the calculated dose was 8.2 (2.1) mg/kg/day. For gentamicin t1/2 was 1.1 (0.5) hours, V was 0.20 (0.06) l/kg, TBC was 2.28 (0.89) ml/min/kg, and the calculated dose was 8.8 (2.4) mg/kg/day. The pharmacokinetic parameters were not statistically different between the two drugs, but the mean values of t1/2 and TBC of CF patients differed significantly from those of the control group. The calculated doses were larger than the manufacturer's maximum recommended dose of 7.5 mg/kg/day for 63% of tobramycin and 71% of gentamicin treatment courses. A dosing interval change to every four hours would have been appropriate in 28 of the 36 treatment courses (78%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗