PubMed Health⌕ Search

Biomedical subjects

D M Angaran

Publications and source records attributed to D M Angaran.

11 recordsLinked to original sources
PubMed1991

Selecting, developing, and evaluating indicators.

A process for selecting and evaluating indicators for use in monitoring the quality of patient care is described. An indicator is a quantitative measure that provides information and reveals ways in which care could be improved. It is a specific set of conditions whose presence signals that the care being provided should be examined. A sample medication-use outcome indicator is discussed to illustrate the steps of indicator evaluation in a paradigm proposed by the National Demonstration Project on Quality Improvement in Health Care. Indicators must be selected according to the needs of the institution: the frequency with which the set of conditions is likely to occur, the risk involved, and the institution's goals and capabilities. Documented data on the indicator must exist and must be adequate for evaluation of care. Analysis and interpretation of the data and a plan for using the information are discussed. For the use of indicators to succeed in improving the quality of care, the total institution must be committed to the process. Pharmacy quality assurance efforts need to move from evaluation of the use of specific drugs (i.e., focus on the product) to continuous measuring, monitoring, and quality improvement.

Data Collection↗
PubMed1990

Oxygen homeostasis: theory, measurement, and therapeutic implications.

The ultimate goal of therapeutic intervention in a critically ill patient is to maintain oxygen homeostasis where delivery of oxygen to the cells is greater than, or at least equal to, the oxygen demand of the cells. Oxygen demand varies from organ to organ. Total body oxygen demand is the sum of all oxygen required by all tissues and organs for aerobic cellular function. Oxygen consumption (VO2) is the quantity of oxygen actually used by the cells. VO2 may be calculated if the values of cardiac output (CO), hemoglobin concentration, and arterial and venous oxygen saturations (SaO2 and SvO2, respectively) are known. Under normal circumstances, the quantities of oxygen demanded and oxygen consumed are equal, but in situations of inadequate oxygen delivery, oxygen demand may not be satisfied and the quantity of oxygen actually consumed will be governed by the quantity delivered. This then may result in an oxygen deficit and, ultimately, cellular death. This article discusses the principles of oxygen homeostasis, techniques for measuring VO2, CO, and SvO2, and the relevance of these principles and techniques to clinical practice.

Carbon Monoxide↗
PubMed1988

Career patterns of pioneer clinical pharmacists.

The career paths of some early clinical pharmacists from their first positions during the years 1965-1974 to their current positions were studied. In August 1985 a group of pharmacists was surveyed to determine (1) the extent to which they had maintained a clinical practice (defined as direct patient contact, including evaluating and planning drug regimens), (2) the number of job-function changes, and (3) the degree of the pharmacists' commitment to public service, as measured by Hall's Belief in Public Service and Allport-Vernon-Lindzey Personality Values. The response rate for the 337 questionnaires was 73.5%. The average age of the group was 40 years; 83% were men, and 79% possessed Doctor of Pharmacy degrees. The respondents had changed job functions an average of 2.1 +/- 1.5 times over the last 13 years since the highest professional degree. The percentage in the job functions of hospital pharmacist and pharmacy faculty declined over time while those in hospital pharmacy administration, academic administration, and the pharmaceutical industry increased. Clinical-practice activity declined over time, with a twofold net increase in those reporting no direct patient-care responsibilities. Male respondents with fewer years after their highest professional degree, a greater belief in public service, higher theoretical values, and no residency experience were more likely to be currently involved in direct patient care than others. Although attrition among pioneer clinical pharmacists is not excessive for those who began their careers with a relatively small percentage of their time devoted to clinical practice, most pharmacists who began with substantial clinical commitments have reduced or eliminated clinical activities over time.(ABSTRACT TRUNCATED AT 250 WORDS)

Career Mobility↗
PubMed1987

The comparative influence of prophylactic antibiotics on the prothrombin response to warfarin in the postoperative prosthetic cardiac valve patient. Cefamandole, cefazolin, vancomycin.

A prospective randomized trial was conducted comparing the effect of three antibiotics: cefamandole (CM), cefazolin (CZ), and vancomycin (V), used as prophylaxis for prosthetic valve surgery, on the prothrombin (PT) response to warfarin (W) on the third day of anticoagulant therapy. Twenty patients, with normal preoperative PTs, were randomized to each antibiotic. Their PTs were not significantly different at 2 hours after operation and the morning before W was begun. The three groups received similar W doses for 2 days, and the PT, as percentage of activity, on the morning of the third day demonstrated that V (51 +/- 18%) was significantly greater (p less than 0.005) than CM (29 +/- 14%) or CZ (38 +/- 18%). CM had a significantly greater percentage of change in PT (64 +/- 14%, p less than 0.0001) from the first to third day than either CZ (51.1 +/- 18%) or V (44.6 +/- 19%). CM also had a greater number of patients (6) with PTs greater than or equal to 30 seconds on day 3 than either CZ (1) or V (1). The antibiotic influence on the PT response to W in this study is ranked as CM greater than CZ greater than V.

Aged↗
PubMed1986

Esmolol hydrochloride: an ultrashort-acting, beta-adrenergic blocking agent.

The chemistry, pharmacology, pharmacokinetics, hemodynamic and electrophysiologic effects, clinical efficacy, adverse effects, drug interactions, compatibility and stability, dosage, and administration of esmolol hydrochloride are reviewed. Esmolol produces competitive blockade of beta receptors in both animals and humans. It does not possess membrane-stabilizing, intrinsic sympathomimetic, or alpha-adrenergic blocking activity. The relative cardioselectivity of esmolol is similar to that of metoprolol. Esterase metabolism accounts for the rapid total body clearance of 285 mL/kg/min and elimination half-life of 9.2 minutes. Its rapid metabolism following continuous intravenous infusion results in the rapid offset of pharmacologic effect after drug administration is discontinued. In patients with supraventricular tachyarrhythmias, esmolol produces rapid control of heart rate in an average effective dosage range from 97.2 to 115.0 micrograms/kg/min and effects that are similar to propranolol. Esmolol is effective and safe in managing tachycardia and hypertension during surgical stress and may be useful in postoperative hypertension or elevated heart rates during myocardial ischemia. Esmolol does not appear to interact with digoxin, morphine, warfarin, or succinylcholine to any clinically important extent. The most frequent adverse effects associated with esmolol infusion are hypotension and phlebitis. Hypotension can be avoided by careful titration, and if encountered, it can be rapidly resolved by dosage adjustment or discontinuation of the infusion. The ultrashort half-life and duration of action of esmolol may allow safer application of beta blockade in critically ill patients.

Adrenergic beta-Antagonists↗
PubMed1977

Hazards of mechanical ventilation--therapeutic implications.

The side effects and adverse reactions associated with the use of positive pressure volume cycle ventilators are described with a focus on information the pharmacist needs to know to monitor patient drug therapy. Mechanical ventilation is discussed with regard to pulmonary and blood gases, infections, cardiovascular effects, renal-fluid status, metabolic considerations, central nervous system effects, gastrointestinal effects, musculo-skeletal reactions, discontinuance of mechanical ventilation and the use of inhalation drugs.

Blood Gas Analysis↗