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Biomedical subjects

D W Raisch

Publications and source records attributed to D W Raisch.

28 records · Page 2Linked to original sources
PubMed1988

Association of length of stay and total hospital charges with antimicrobial regimen changes.

The association of changes in antimicrobial therapy with length of stay and total hospital charges in a 600-bed general medical hospital was studied. Changes in antimicrobial regimens were examined in three diagnosis-related groups (DRGs): DRG 79 (respiratory infections and inflammations, age greater than 69 years, and/or secondary diagnosis), DRG 89 (simple pneumonia and pleurisy, age greater than 69 years, and/or secondary diagnosis), and DRG 416 (septicemia, age greater than 17 years). These changes were defined as follows: (1) switching from one drug or drug combination to another, (2) adding one or more drugs to a regimen, or (3) discontinuing one drug of a multiple-drug regimen. Variables examined for association with these changes were length of hospital stay and pharmacy, antimicrobial, intravenous therapy, and hospital charges. In DRGs 79 and 89, changes in antimicrobial regimens were associated with significantly longer hospital stay and significantly higher pharmacy, antimicrobial, intravenous therapy, and total hospital charges. In DRG 416, changes in antimicrobial regimens were not associated with higher charges or longer stay. Significant differences among DRGs were found with respect to the types of changes, with more changes from broad- to narrow-spectrum coverage occurring in DRGs 89 and 416 than in DRG 79. At this institution, patients whose antimicrobial regimens were changed had significantly longer hospital stays and higher charges in two of three DRGs.

Anti-Bacterial Agents↗
PubMed1986

The effects of DRGs and cost-containment: assessment by hospital pharmacy directors.

With the advent of prospective reimbursement, cost containment has increasingly come into focus. Arizona hospital pharmacy directors were surveyed to learn what effect DRG-based payments and other capitation programs have had on their pharmacy department and hospital. Their responses concerning effects on staffing and services are outlined. Descriptions of successful and unsuccessful cost-containing measures are provided, and pharmacists' perceptions of the effect of DRGs and the problems they see with cost containment are detailed. It is evident that P & T Committees will play an ever-increasing role as an important interface with hospital staff in resolving many cost-containment issues.

Arizona↗
PubMedDate not supplied

Survey ranking of emetogenic control in children receiving chemotherapy.

PURPOSE: To determine the effect of standard antiemetic treatment in children receiving various combination chemotherapy regimens. METHODS: A validated nausea/vomiting survey was administered to 78 patients receiving 13 different emetogenic chemotherapy regimens. Patients received antiemetic prophylaxis with ondansetron (0.3 mg/kg/day) alone for moderately emetogenic chemotherapy regimens or ondansetron (0.45 mg/kg/day) and methylprednisolone (4 mg/kg/day) for severely emetogenic chemotherapy regimens. A total of 324 different courses of chemotherapy were surveyed. Nausea and vomiting severity, duration, number of emetic episodes, appetite, daily activity interference, and rates of both complete and good antiemetic protection were determined for each chemotherapy protocol. Differences between genders and ages were analyzed. RESULTS: Chemotherapy combinations containing platinum compounds were found to be highly emetogenic and nauseating despite antiemetic therapy with ondansetron plus a corticosteroid. In addition, complete antiemetic protection for the combination of vincristine, cyclophosphamide, and dactinomycin was poor. For most of the severely emetogenic chemotherapy protocols, patients experienced good protection from nausea and vomiting less than 60% of the time, despite the use of ondansetron plus methylprednisolone. Significant differences were found in rates of residual nausea and vomiting and failure of antiemetic protection among the severely emetogenic chemotherapy protocols despite identical antiemetic therapy. Good protection rates were higher for moderately emetogenic chemotherapy treated with ondansetron alone. CONCLUSIONS: The currently recommended prophylactic therapy for pediatric patients receiving severely emetogenic chemotherapy fails to provide protection for many patients receiving commonly administered chemotherapy regimens and for most pediatric patients receiving platinum-containing chemotherapy combinations. New and refined antiemetic strategies are needed to improve efficacy in the pediatric population.

Age Factors↗
PubMedDate not supplied

Evaluation of a non-Food and Drug Administration-approved use of cimetidine: treatment of pruritus resulting from epidural morphine analgesia.

The purpose of this study was to evaluate the efficacy of a frequently used treatment at our hospital, intravenous cimetidine hydrochloride for pruritus resulting from epidural morphine sulfate analgesia in cesarean-section patients. Fifty-two patients were randomly assigned to receive either placebo or cimetidine 300 mg i.v. Thirty-nine patients experienced itching. Thirty-three patients completed the study (17 in the cimetidine group, 16 in the placebo group). For pruritus unrelieved by the study drug, bolus doses of naloxone hydrochloride 0.2 mg i.v. were administered at 30-minute intervals, if needed. Pruritus was assessed by two subjective rating scales and the number of naloxone doses needed for unrelieved pruritus. Using independent Student's t-tests, we identified no significant differences between the two groups. The mean numbers of naloxone boluses administered were 1.9 for placebo and 2.5 for cimetidine (p = 0.49). Our study demonstrates the importance of objectively evaluating the use of drugs for non-Food and Drug Administration-approved indications.

Adult↗
PubMedDate not supplied

Relationships among prescription payment methods and interactions between community pharmacists and prescribers.

OBJECTIVE: This research was performed to examine community pharmacists' interactions with prescribers and to determine if these interactions are related to payment method. DESIGN: Randomly selected pharmacists (47 in chain pharmacies and 26 in independent pharmacies) collected data concerning prescriber interactions for a 40-hour period. These interactions were analyzed in terms of payment methods, prescriber acceptance, and types of information discussed. RESULTS: Information concerning 730 interactions by 72 pharmacists was obtained. Payment methods were related to the frequency of interactions per pharmacist (p less than 0.01). There were higher percentages of interactions for self-pay (median 2.2 percent) and Medicaid (median 1.8 percent) prescriptions than for third-party fee-for-service (mode 0 percent) or capitation prescriptions (mode 0 percent). Type of information discussed was related to payment method. The vast majority of information provided by pharmacists (91 percent) was accepted by prescribers. The rate of acceptance was 97 percent for prescriber-initiated interactions versus 88 percent for pharmacist- or patient-initiated interactions (p less than 0.01). CONCLUSIONS: Relationships between payment method and interactions were identified. These findings may be attributable to prescribing policies and reimbursement policies. Prescribing policies that restrict prescribers to a formulary may help make them become more adept at using those products; thus, they will make fewer prescribing errors. Reimbursement policies that require patients to consistently use a specific pharmacy (i.e., capitation) may help pharmacists become more familiar with the patient's prescription history. Therefore, interactions with prescribers are needed less frequently for these patients' prescriptions.

Capitation Fee↗
PubMedDate not supplied

Understanding quality-adjusted life years and their application to pharmacoeconomic research.

OBJECTIVE: To provide a basic overview of quality-adjusted life years (QALYs) and their application in cost-effectiveness analysis (CEA), compare and contrast QALYs with other health-related quality-of-life (HRQOL) assessments, describe current controversies regarding QALYs, and provide comparisons between QALY instruments. METHODS: The literature regarding HRQOL and QALYs was reviewed and key issues are summarized. RESULTS: QALYs provide relative preferences of patients for different health states. They range from 0, representing death, to 1.0, representing optimal health. QALYs are distinguished from other HRQOL assessments in that they provide a summary measurement that incorporates quantity of life in addition to HRQOL. When QALYs are used as the outcome measure in CEA, a cost per QALY is calculated. The Panel on Cost Effectiveness in Health and Medicine has recommended that QALYs be used as outcome measures in CEA; when QALYs are used in CEA, comparisons between treatments for different illnesses as well as within an illness are possible. The three most commonly used preference measurement techniques in determining QALYs are visual analog scales, time trade-off, and standard gamble. Controversies regarding QALYs include which preference measurement technique is most appropriate, whether QALY assessments should be obtained from patients or the community, and how to address states, such as coma, that individuals sometimes assess as worse than death. QALY instruments can be compared regarding preference measurement technique, HRQOL domains assessed, ease of administration, validity, reliability, and sensitivity. CONCLUSIONS: When used appropriately, QALYs provide valuable outcome measures for pharmacoeconomic research.

Cost-Benefit Analysis↗
PubMedDate not supplied

Differences among raters evaluating the success of EMLA cream in alleviating procedure-related pain in children with cancer.

We evaluated the analgesic efficacy of EMLA cream after repeated bone marrow aspirations or lumbar punctures (LPs) in children with cancer, and compared the ratings among patients, their parents, physicians, and nurses. Data from LPs were analyzed at the last procedure without EMLA (T1) and the first and last procedures with EMLA (T2 and T3). Friedman's nonparametric analysis of variance was used for statistical analysis. A total of 272 procedures in 29 children were analyzed. For 179 procedures without EMLA, physicians rated pain lower than other raters, and for the 93 with EMLA physicians rated pain less than the children. Children rated pain at T2 lower than at T1 or T3. Physicians rated pain at T2 less than at T3. Both children and physicians rated pain at T3 as not different from that at T1. No differences were noted at these time points for other raters in LP distress ratings, or in bone marrow aspiration pain or distress ratings. Thus EMLA was associated with decreased pain ratings for LPs, but this effect was not sustainable with repeated procedures. The cream alone should not be relied on to control pain of bone marrow aspiration or repeated LPs in children. Physicians underestimated pain, which may have implications for undertreatment in this patient population.

Adolescent↗