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Biomedical subjects

D L Sullivan

Publications and source records attributed to D L Sullivan.

10 recordsLinked to original sources
PubMed1994

Antepartum corticosteroids: disease stabilization in patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP)

OBJECTIVE: Our purpose was to evaluate the impact of antepartum administration of corticosteroids on the course of the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP) in pregnancies at 24 to 37 weeks' gestation. STUDY DESIGN: This prospective, randomized study was undertaken in 25 antepartum patients with atypical severe preeclampsia expressed as HELLP syndrome. Twelve pregnant women were randomized to receive double-dose dexamethasone (10 mg intravenously every 12 hours) until delivery, and 13 women were randomized to the control arm. Management and delivery decisions for all patients were based on a common protocol, with delivery undertaken for a deteriorating maternal or fetal condition. RESULTS: In the corticosteroid-treated group the maternal platelet count significantly increased (p = 0.006), whereas lactic dehydrogenase and alanine aminotransferase significantly decreased over time (p = 0.03 and p = 0.005) in comparison to the 13 women who did not receive corticosteroids. Maternal urinary output after entry into the study was significantly increased within hours after steroid administration versus the control group (p = 0.0006). The study entry-to-delivery interval (41 +/- 15 hours) was significantly longer in the group of steroid-treated women (p = 0.0068). CONCLUSIONS: Stabilization and significant improvement in the laboratory and clinical parameters associated with HELLP syndrome occurred in women who received high-dose antenatal corticosteroids, as measured by maternal platelet count, urinary output, lactic dehydrogenase, alanine aminotransferase, and postponement of delivery. We believe the findings of this investigation permit us to speculate that this therapeutic approach could enhance maternal-fetal care by postponing delivery of some previable fetuses, reduce the need for maternal transfusion of blood products, reduce neonatal morbidity or mortality from multiple systemic effects, and facilitate a safer transfer of the ill mother to a tertiary care site for optimal peripartal care.

Adolescent↗
PubMed1994

Extrafascial wound dehiscence: deep en bloc closure versus superficial skin closure.

OBJECTIVE: To determine closure time, pain experienced during closure, and healing time in patients undergoing deep en bloc closure or superficial skin closure of extrafascial would dehiscence. METHODS: Patients with extrafascial wound dehiscence on the obstetrics and gynecology service of the University of Mississippi Medical Center were randomized to deep en bloc closure or superficial skin closure. A 1:2 ratio was used to evaluate superficial skin closure, as deep en bloc closure is known to be effective. The wounds of patients in the deep en block group were closed with no. 1 polypropylene placed through the entire wound thickness as simple interrupted sutures. The wounds of patients in the superficial closure group were closed with 2-0 polypropylene placed through the skin as vertical mattress sutures. The wounds were closed on the patient care unit under local anesthesia. Closure was timed in minutes from initiation of local anesthesia to cutting of the last suture. Patients assessed pain by placing a mark on a 100-mm line (0 = none; 100 = maximum). Time for complete healing was measured from wound disruption to skin reepithelialization. RESULTS: During an 8-month period, seven patients were randomized to deep en bloc closure and 16 to superficial skin closure. The en bloc group required 27.1 +/- 5.5 minutes (mean +/- standard deviation) for closure, compared with 18.9 +/- 3.4 minutes in the superficial group (P < .001). The mean pain score in the en bloc group was 43.4 +/- 23.2 mm, compared with 16.6 +/- 11.4 mm in the superficial group (P < .001). The en bloc group required 22.7 +/- 7.7 days for complete healing, compared with 19.8 +/- 5.3 days in the superficial group, a nonsignificant difference. CONCLUSIONS: Superficial skin closure of extrafascial wound dehiscence appears to be superior to deep en bloc closure in terms of closure time and pain experienced during the procedure. These benefits are achieved with minimal risk while allowing timely wound healing.

Abdomen↗
PubMedDate not supplied

Frequency and severity of sexual harassment in pharmacy practice in Ohio.

OBJECTIVE: To determine the frequency and severity of sexual harassment in the pharmacy workplace for both male and female pharmacists, and to identify: (1) instigators, (2) places of occurrence, and (3) pharmacists' responses. DESIGN: Mailed survey using elements of the Sexual Experience Questionnaire (SEQ). One repeat mailing to nonrespondents. SETTING: Community pharmacies, hospital pharmacies, other pharmacies in the state of Ohio. PATIENTS AND OTHER PARTICIPANTS: 789 randomly selected pharmacists registered in Ohio. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Amount of gender harassment, unwanted sexual attention, and sexual coercion; differences in occurrences of sexual harassment between men and women; identification of instigators as colleagues, patients, or supervisors; identification of place of occurrence as community pharmacy, hospital pharmacy, or elsewhere; pharmacists' responses and reactions. RESULTS: After two mailings, 265 usable surveys were returned for a response rate of 34%. Women differed significantly from men in total occurrences of sexual harassment, with men reporting 183 instances of sexual harassment and women reporting 281 such experiences. Instigators were colleagues (43%), patients (30%), and superiors (27%). Men reported 143 experiences of unwanted sexual attention, whereas women reported 272 such occurrences. Colleagues were responsible for 47% of instances of unwanted sexual attention, patients were responsible for 37%, and superiors 16%. No significant differences were found between men and women in total number of occurrences of sexual coercion. CONCLUSION: Sexual harassment in the workplace has been experienced by both male and female pharmacists. Women experienced more hostile work environment harassment than did men. However, quid pro quo harassment did not differ significantly between the sexes.

Adult↗
PubMedDate not supplied

Comparison of methods used for estimating pharmacist counseling behaviors.

OBJECTIVE: To compare the rates reported for provision of types of information conveyed by pharmacists among studies for which different methods of estimation were used and different dispensing situations were studied. DATA SOURCES: Empiric studies conducted in the US, reported from 1982 through 1992, were selected from International Pharmaceutical Abstracts, MEDLINE, and noncomputerized sources. STUDY SELECTION: Empiric studies were selected for review if they reported the provision of at least three types of counseling information. DATA EXTRACTION: Four components of methods used for estimating pharmacist counseling behaviors were extracted and summarized in a table: (1) sample type and area, (2) sampling unit, (3) sample size, and (4) data collection method. In addition, situations that were investigated in each study were compiled. DATA SYNTHESIS: Twelve studies met our inclusion criteria. Patients were interviewed via telephone in four studies and were surveyed via mail in two studies. Pharmacists were interviewed via telephone in one study and surveyed via mail in two studies. For three studies, researchers visited pharmacy sites for data collection using the shopper method or observation method. Studies with similar methods and situations provided similar results. CONCLUSIONS: Data collected by using patient surveys, pharmacist surveys, and observation methods can provide useful estimations of pharmacist counseling behaviors if researchers measure counseling for specific, well-defined dispensing situations.

Behavior↗
PubMedDate not supplied

Improving efficiencies in pharmaceutical distribution channels using the economic order quantity model.

The purpose of this study was to investigate empirically the potential cost savings to a pharmaceutical wholesaler using the Economic Order Quantity (EOQ) model. This model allows for calculating the order quantity that minimizes both ordering and holding costs. A regional pharmaceutical wholesaler was selected for a case analysis study using the EOQ model. Eleven brand name products were randomly selected for the analysis. The average yearly cost savings using EOQ was $31.92 per product. The potential yearly cost savings based on 8500 brand name stock-keeping units was $271,320. Using EOQ can therefore assist pharmaceutical wholesalers in minimizing holding and ordering costs and improve efficiency for pharmaceutical distribution channels.

Cost Savings↗
PubMedDate not supplied

Comparison of intra-amniotic (15S)-15-methyl-PGF2 alpha and intravaginal prostaglandin E2 for second-trimester uterine evacuation.

OBJECTIVE: To compare the efficacy, safety, and side effects of intra-amniotic (15S)-15-methyl prostaglandin F2 alpha (15-M-PGF2 alpha) and intravaginal prostaglandin E2 (PGE2) for midtrimester uterine evacuation. STUDY DESIGN: Ninety-three patients underwent therapeutic midtrimester pregnancy termination by the use of laminaria placement and intra-amniotic injection of 15-M-PGF2 alpha. A matched control group underwent uterine evacuation by laminaria placement and insertion of PGE2 intravaginal suppositories. The main outcomes studied were time to delivery, side effects, and complications. RESULTS: The 15-M-PGF2 alpha group had a shorter time to delivery (12.3 +/- 6.4 hours) compared with the PGE2 group (16.2 +/- 6.6 hours, p < 0.0001). The evacuation rate over time was significantly greater in the 15-M-PGF2 alpha group (p = 0.001). The PGE2 group had a significantly higher incidence of side effects. CONCLUSIONS: The use of intra-amniotic 15-M-PGF2 alpha for therapeutic second-trimester pregnancy termination is safe and is associated with a more rapid evacuation of the uterus and fewer side effects than intravaginal PGF2 suppositories.

Abortifacient Agents, Nonsteroidal↗