Biomedical subjects

E P Larrat

Publications and source records attributed to E P Larrat.

11 recordsLinked to original sources

PubMed2000

Patient compliance and blood pressure control on a nuclear-powered aircraft carrier: impact of a pharmacy officer.

The impact of a pharmacy officer on patient compliance and blood pressure control on a deployed nuclear-powered aircraft carrier for a 2-week at-sea period was evaluated. Before any counseling by a pharmacy officer, 43 crewmembers on chronic medications anonymously completed a compliance questionnaire. The pharmacy officer then counseled these crewmembers. A follow-up compliance questionnaire was completed 2 weeks later. After counseling, compliance had increased 58% (p < 0.0001) from compliance measured before counseling. The pharmacy officer also initiated therapeutic interventions. Among 26 crewmembers diagnosed as hypertensive, preintervention blood pressure (BP) measurements were obtained. Ten to 14 days after the initial BP measurement, BP was remeasured. After intervention, 31% (p < 0.02) more crewmembers were at BP goal compared with before intervention. A pharmacy officer, working closely with a medical officer, improved patient compliance and blood pressure control. One problem identified was that these warships require computer software that can prospectively identify drug-drug interactions.

Blood Pressure↗

PubMed1996

Cocaine use and HIV disease progression among heterosexuals.

Evidence derived fromin vitro experiments would suggest that cocaine exposure may hasten the progression of HIV disease among infected individuals. Epidemiologic support for this association is equivocal at best. We examined the relationship between cocaine use and decline in CD4 cell counts over a 6-month period in a cohort of 81 heterosexually active men and women who were infected with HIV. Overall, cocaine users were 1.4 times (90% CI=1.0-2.1) more likely to experience a decline in CD4 count than were non-cocaine users. Cocaine users with a baseline CD4 count of greater than 500 cells/mm(3) were at 1.6 times (90% CI=1.2-2.3) greater risk for a CD4 decline than non-cocaine users at this baseline CD4 level. Concurrent treatment with an antiretroviral agent [AZT] modified the strength of this association, as evidenced by a cumulative incidence ratio (CIR) of 0.4 (90% CI=0.1-1.3) among AZT users and a CIR=2.2 (90% CI=1.5-3.2) among those not undergoing AZT treatment. The results of this study raise concerns about the negative effects of cocaine on people living with HIV infection, particularly those not receiving antiretroviral therapy who entered our study with a relatively intact immune system.

Journal Article↗

PubMed1996

Screening for peripheral arterial disease.

Peripheral arterial disease (PAD) is an age-dependent condition that limits ambulation and compromises quality of life in an estimated two million Americans. Early detection and treatment is essential for minimizing the signs and symptoms of PAD. Using a methodology developed by the National Council on the Aging, a noninvasive screening program was conducted for this disease in a population of 1,092 elderly ambulatory Rhode Island residents. Possible PAD was detected in 17.7% of the subjects, while 42% were identified as being at high risk for the disease.

Aged↗

PubMed1996

Regulatory environment and psychotropic use in board-and-care facilities: results of a 10-state study.

BACKGROUND: Largely unsupervised administration of drugs and the potential for overuse of psychotropic agents in residential care facilities have emerged as major public policy concerns. In a large multistate study, we examined patterns of psychotropic prescription and use by facility licensure status and the extensiveness of state regulations. METHODS: Descriptive analyses were based on a sample of 2,949 residents from 493 board-and-care facilities in 10 states, drawn via a complex, multistage sampling design. States were purposively selected based on the stringency of their board-and-care regulatory system, and samples of facilities were drawn, stratified by licensure status and home size. Residents were randomly selected within the sampled facilities. Weighted analyses were performed with Software for Survey Data Analysis (SUDAAN), accounting for the complex sampling design. RESULTS: Approximately 43% of the residents were prescribed and 41% used at least one psychotropic agent, primarily on a routinely scheduled basis. Antipsychotics were prescribed to 22% and used by 21%; antidepressants were prescribed to 17% and taken by 16%; antimanic agents were prescribed to and used by 4%; and anxiolytics, sedatives, or hypnotics were prescribed to 17% and used by 14%. Among psychotropic users, over 50% had not had mental health services in the prior year; 25% had no psychiatric history. Among licensed facilities, prescription and use of psychotropics, particularly antipsychotics, was significantly higher among residents of homes located in states with limited regulatory systems. CONCLUSIONS: Results revealed high rates of psychotropic prescription and use, and not inconsequential levels of polypharmacy - within and across therapeutic classes - among board-and-care facility residents. Frequently, psychotropics were not used as an adjunct to alternative treatments, and were not associated with a psychiatric history. Extent of psychotropic use was related to the regulatory environment, suggesting that more extensive regulations and monitoring may reduce psychoactive drug use in board-and-care facilities, and more adequately ensure the appropriateness of such treatment.

Adolescent↗

PubMed1995

Psychotropic use among older residents of board and care facilities.

OBJECTIVE: To describe patterns of psychotropic use as well as clinically relevant and concurrent nonpsychotropic use among older residents of board and care facilities in 10 states. METHODS: Weighted use rates were based on data from a sample of 2054 residents aged 65 and older from 410 facilities in 10 states, drawn via a complex, multistage sampling design. Data, including drug name, use frequency, and PRN use, were collected on all drugs taken by the resident during a 7-day period. During face-to-face interviews with residents and/or proxies, data were also collected on resident characteristics. SUBJECTS: The majority of subjects were female, white, and widowed. Average age was 82 years. Approximately 25% had a current mental or emotional condition, and 8% had been hospitalized for a psychiatric condition during the year before admission. More than half needed help with at least one activity of daily living. Forty percent had moderate or severe cognitive impairment, and 18% had received mental health care during the previous year. ANALYSES: Weighted descriptive analyses were performed with Software for Survey Data Analysis (SUDAAN), which accounts for the complex, multistage sampling design. RESULTS: Approximately 35% of the older residents used at least one psychoactive agent, with 30% of psychotropic users receiving two to four different psychotropic medications. Use rates decline with age, for psychotropics overall and for therapeutic classes. Results revealed potentially problematic polypharmacy in relation to drug duplication within therapeutic classes, use of multiple psychotropics across classes, and concurrent nonpsychotropic use. CONCLUSIONS: Compared with community-dwelling older adults, this study revealed high psychotropic use rates among older board and care facility residents. Overall, our results suggest that serious consideration be given to the apparent need for systematic drug utilization review, a potentially useful program that is mandated in other settings.

Aged↗

PubMed1994

Cocaine use and heterosexual exposure to human immunodeficiency virus.

We examined the relation between recent cocaine use and heterosexual exposure to human immunodeficiency virus (HIV). Five hundred nineteen heterosexually active participants in the New England Behavioral Health Study, an HIV testing and counseling program, provided information for this study. The outcome measure included behaviors that increased the risk for exposure to HIV via contact with infected genital secretions. Nearly one-third (31.8%) of participants reported use of cocaine during the year before study entry. These individuals were 1.3 times [90% confidence interval (CI) = 1.1-1.7] more likely to risk HIV exposure than people not using cocaine during this period, with evidence of a dose-dependent relation among HIV-positive cocaine users. HIV-positive crack users were at 1.9 times greater risk (90% CI = 1.2-2.9) for HIV risk-taking behavior than those who did not use crack. The effect of cocaine was present even among those individuals without other injection drug use.

Adult↗

PubMed1994

Cost-effectiveness study of nitrate therapy using a decision analysis methodology.

The cost-assessment technology of decision analysis was applied to isosorbide dinitrate (ISDN), the standard therapy for angina; isosorbide mononitrate (ISMO), approved mid-1992; and nitroglycerin patches to measure the effect of economics on clinical practice and administrative choices. The evaluation was conducted to illustrate the utility of this method for decision makers in various sectors of the health care system, including physicians, pharmacy benefit administrators, formulary committees, and manufacturers. Findings indicate that despite a higher unit cost for ISMO, total anticipated treatment costs with this new long-acting nitrate are lower than those associated with ISDN (28%) and nitroglycerin patch (16%) therapy in patients with stable angina, and ISMO requires less dosing titration and is associated with fewer tolerance effects.

Angina Pectoris↗

PubMed1992

Update on the treatment of Alzheimer's disease.

The research and clinical experience of the past decade have provided a wealth of new knowledge about the causes of AD and the treatment of individuals afflicted with this progressive, irreversible illness. Public awareness of the costs of the disease has increased both at a national level and at a family and individual level. Despite these advances, the care and treatment of the AD patient are complex in that the risks of therapy often outweigh benefits. The pharmacists can play a key role by ensuring rational therapy, providing professional support to AD care givers, and serving as a source of information in both the ambulatory and institutional patient settings.

Aged↗

PubMed1990

Compliance-related problems in the ambulatory population.

When prescription drugs are taken in the correct dose and the correct manner, they have great potential for improving the quality of medical care, but inappropriate and incorrect administration of these drugs can lead to severe health problems. Risk factors for problems related to prescription drug compliance were examined in a cross-sectional retrospective study (n = 1017) of ambulatory individuals who had undergone a Brown Bag Prescription Evaluation Program consultation. A pharmacist interviewer assessed drug-related problems such as duplication of drug product, overutilization and underutilization of medication, drug interactions, and side effects. Associations between specific medication-related problems and patient characteristics (demographics, medical history, and insurance status) were studied. Factors that appear to be associated with compliance problems include a patient's level of understanding of both medication instructions and the drug therapy, length of time since last physician visit, length of time on medication, total number of medications, and number of drug allergies. The class of medication taken was also found to be a significant predictor of excess risk. The age and sex of an individual appear to have little association with the development of compliance-related problems. The study reinforces the need for frequent patient contact with a health care professional and the value of educating the patient about the medication regimen.

Ambulatory Care↗

PubMed1986

Pain cocktails: survey of formulations used in US hospitals.

Brompton's cocktail is an oral formulation used widely for intractable pain associated with cancer. In the United States, however, formulations are not standard, and questions concerning the efficacy and safety of some ingredients have been raised. Hospitals were surveyed to determine the formulation of Brompton's cocktail used, how the cocktail is compounded, and who is responsible for deciding on the pain cocktail formula. Controversy surrounding the use of cocaine as an ingredient is discussed, and problems with dating of formulations are described. P & T Committees are encouraged to review the literature concerning pain cocktail formulations and reevaluate the use of pain cocktails within their own institutions.

Analgesics↗

PubMedDate not supplied

Entangled epidemics: cocaine use and HIV disease.

Over the past decade, two epidemics have had a severe impact on public health in this country. These health problems involve cocaine abuse and AIDS (or HIV disease). The processes of these two conditions are clearly not independent of each other and may be quite complex. Understanding of this relationship has been hampered by a myriad of social, biological and behavioral variables that are entangled with the basic cocaine-HIV association. This article presents a paradigm for discussion of the interaction between cocaine exposure and HIV disease based on three mechanisms: the relationship between cocaine exposure and increased opportunity for HIV exposure, the direct role that cocaine plays in altering susceptibility to HIV infection, and the influence that cocaine use has on the progression of HIV disease. The goal of this structured approach is to enhance conceptual understanding of the cocaine-HIV relationship while recognizing the complexity of the issue and the limitations of current research efforts. This model will serve as a framework for the discussion of implications for future research, clinical practice, and public policy.

Cocaine↗