PubMed Health⌕ Search

Biomedical subjects

H T Hatoum

Publications and source records attributed to H T Hatoum.

18 recordsLinked to original sources
PubMed1991

Multilevel model to assess appropriateness of pediatric serum drug concentrations.

A multilevel model reviewing four assessment levels for pediatric serum drug concentrations was developed. Criteria for appropriate indication, sample collection, documentation, and utilization were based on therapeutic drug monitoring principles. The model was applied to 222 pediatric serum drug concentrations. Inadequate documentation was a major problem, but it occurred at a lower rate (37%) than previously reported. The rates of inappropriateness for indication (15%), sample collection (16%), and utilization (10%) were well within reported ranges but were significantly lower with pharmacy input. Overall, 48.2% of drug concentrations were inappropriate. Digoxin, phenobarbital, and aminoglycosides had the highest error rates. The annualized cost of inappropriate serum drug concentrations was $12,325. The described method allows for targeting of educational programs with defined areas for improvement. The findings of this study also support the involvement of clinical pharmacists in the therapeutic drug monitoring process.

Costs and Cost Analysis↗
PubMed1991

Patient outcome and the future practice of pharmacy.

The societal move to focus on patient healthcare outcomes as a measure of provider performance is discussed. Recent steps taken by the Joint Commission on Accreditation of Healthcare Organizations to include outcome criteria as part of its accreditation process represent one such example. Pharmacists must define and defend their role in patients' pharmacotherapy in terms of patient outcomes. Collective actions needed by pharmacists are recommended.

Forecasting↗
PubMed1991

Program to improve nurses' knowledge of pediatric emergency medications.

The effects of an educational program designed to improve nurses' knowledge of the use of emergency medications in the pediatric intensive-care unit (PICU) are reported. The clinical pharmacist for a six-bed PICU and a clinical nurse educator developed a program to assess and extend PICU nurses' knowledge of emergency medications with respect to calculations of bolus and continuous infusions, pharmacology, and proper dosage and administration route. The program consisted of a pretest, a pharmacology lecture, calculation problems, a hands-on practicum, and a posttest. Drugs covered were atropine sulfate, sodium bicarbonate, calcium gluconate, calcium chloride, dopamine hydrochloride, dobutamine hydrochloride, epinephrine hydrochloride, isoproterenol hydrochloride, lidocaine hydrochloride, sodium nitroprusside, and norepinephrine bitartrate. A retest was given 13 months after the pretest. The program was completed by 21 nurses over seven months. There was a significant difference between the mean pretest score, 69.5%, and the mean posttest score, 87.3%, due to improvements in scores for the calculation questions. There was no significant difference in the mean time required to complete the pretest and the posttest. A significant correlation was observed between pretest score and months spent practicing in the PICU. Time to take the retest was significantly shorter than the posttest time, and scores continued to improve. An educational program developed cooperatively by pharmacy and nursing improved specific measures of PICU nurses' knowledge of emergency drugs.

Chicago↗
PubMed1990

Inconsistencies in the drug use process.

Rational drug therapy has historically been viewed as the right drug, in the right dose, at the right time, for the right patient. Today, the emphasis on cost containment has added an extra dimension: cost-effective therapeutic regimens. Most stages of the DUP have not been extensively studied. Evidence presented to date reflects duplication of efforts and suboptimal decisions, with little concerted effort to identify means for improvements that may have a favorable impact on cost and patient outcome. The increasing use of drugs as the primary mode to treat diseases, the reduction in the number of hospital employees at a time increased severity of patient illness, the nursing shortage, and the increasing cost and complexity of drugs, along with the inconsistencies that exist in drug use, demonstrate a need for a complete review of the DUP. The DUP, as it currently operates, is not conducive to the provision of a systematic approach to therapy. The stages in this process are often independent of each other and poorly performed by a variety of health professionals. The subsequent development of strategies for improving the chance for optimal drug therapy through the use of pharmacists as drug therapy experts is needed. The pharmacy profession is in a prime position where expanded patient care services and supervision of the entire DUP may actually decrease the total cost of health care. This expansion represents the key to increasing acceptance of pharmacists' clinical role and for ensuring long-term survival of the profession.

Cost-Benefit Analysis↗
PubMed1990

Microcost analysis of inpatient dispensing and administration of oral solids.

The labor cost of dispensing, administering, and monitoring unit dose oral solid dosage forms (UDs) in a large teaching hospital was determined by microcost analysis. The costs associated with UDs dispensed by the midnight central pharmacy and by a satellite pharmacy were evaluated by use of both work-sampling and time-and-motion studies. Pharmacy personnel activities were classified as direct, auxiliary, or nonproductive. A nursing productivity index was used to determine the nursing time consumed in the administration and monitoring of UDs. The pharmacy labor cost was lowest ($0.14 each) for UDs dispensed from the central pharmacy in the 24-hour medication cart. For each UD that was not dispensed in the 24-hour cart, the labor cost was $0.25 for the central pharmacy and $1.37 for the satellite pharmacy. It took nurses 223.8 sec to administer and monitor a scheduled UD, for a cost of $0.82. The total nursing time spent per nonscheduled UD for administration and monitoring was 574.2 sec; the cost was $2.11. Microcost analysis can be used to isolate the costs of dispensing oral solids in an inpatient setting.

Chicago↗
PubMed1988

Evaluation of the contribution of clinical pharmacists: inpatient care and cost reduction.

Clinical pharmacists in this study hospital reported 1027 interventions in patient drug therapy over two time periods of three and two weeks, respectively. These interventions were subjected to self and peer reviews and to cost-avoidance evaluation. The most frequent type of intervention was recommendations related to drug selection (29.6 percent). Recommendations were not implemented by physicians in only 10.2 percent of the cases. The perceived impact of these interventions on the quality, cost, or both was found by the peer reviewers to occur in 58.5, 16.1 and 25.6 percent of the cases, respectively. Also, when peer reviewed for clinical significance, 983 of these interventions were judged to improve drug therapy to an acceptable level based on the professional literature, and 36 were deemed very significant in terms of saving patients' lives or preserving major organ functions. Of the 983 interventions rendering drug therapy to an appropriate level, 398 were deemed to have cost-avoidance impact; of this number a 25 percent random sample was subjected to cost-avoidance evaluation. Realized cost-avoidance averaged $242 for each intervention implemented. When extrapolated annually, $364,900 was the net realized cost-avoidance after discounting for the cost of providing clinical pharmacy services. An average cost-avoidance of $860.50 was calculated for each intervention made by pharmacists, but not followed by physicians, for an annual potential cost-avoidance of $532,650. In all, clinical pharmacists had the potential to save $897,550 annually in hospital resources if all their interventions had been accepted and implemented.

Cost Control↗
PubMed1988

Cost justification of clinical pharmacy services on a general surgery team: focus on diagnosis-related group cases.

We used a novel approach to cost-justify clinical pharmacy services on a general surgery team in nine diagnosis-related group cases. The clinical pharmacist monitored nine patients longitudinally on a general surgery team from admission to discharge and intervened in their therapeutic management. Each recommendation was analyzed for rationale, acceptance, perceived impact on quality and/or cost of patient care, whether self-initiated or solicited, and impact on patient outcome. Types of recommendations and outcomes were categorized by process and outcome measurement criteria. Total cost avoidance per patient was calculated using costs of drug therapy, laboratory tests, and length of stay. Accounting for cost of clinical pharmacy services, net cost avoidance per patient was calculated. The clinical pharmacist made 101 recommendations on nine patients. Physicians accepted 82 percent of the recommendations; 77 percent of the recommendations were self-initiated and 23 percent were solicited. Recommendations had a perceived impact on cost, quality, or both at 13, 31, and 56 percent, respectively. Most recommendations (79 percent) brought patient therapy to a level of conformance with current standards of practice as documented in the medical literature. Recommendations that potentially preserved a major organ function by preventing drug-induced toxicity or the exacerbation of existing problems constituted 16 percent of the total. None of the accepted recommendations adversely affected patient outcome and 23 percent directly resulted in a measurable positive outcome in patient care. A total of four hospital days was potentially saved for two cases. Based on objective outcome criteria, a 1.9-day increase in therapeutic control was documented per patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-Benefit Analysis↗
PubMed1988

Physicians' review of significant interventions by clinical pharmacists in inpatient care.

Clinical pharmacists in this study hospital reported 1027 interventions in patient drug therapy over two time periods of three and two weeks each. When peer-reviewed for clinical significance, 36 of these interventions were deemed significant in terms of saving patients' lives or preserving major organ functions; 983 were judged to improve drug therapy to an acceptable level based on standards of the professional literature (8 recommendations were informational i.e., not clinically significant). These 36 interventions were subjected to an independent, blind review by three practicing physicians who were given the same ranking system for clinical relevance as the one used by the peer reviewers. The physicians independently concurred with the peer reviewers on the two interventions initially ranked as 6 (lifesaving in nature). Of the interventions ranked 5 (preserving major organ functions) by the peer-review group, 53 percent were given a rank of 5 by the physicians. However, the remaining 47 percent were given a rank of 4 (upgrading patient drug therapy to the most appropriate level based on professionally accepted standards). In this era of program evaluation and justification, the process of encouraging other health professionals to review pharmacists' contribution to patient care should not be overlooked.

Drug Therapy↗
PubMed1988

Microcost analysis of the prescription dispensing process in an outpatient hospital pharmacy.

The costs involved in dispensing a prescription in an outpatient pharmacy at a 450-bed teaching hospital were studied. Work sampling was used to determine pharmacist and technician time involved in dispensing a prescription, and other direct and indirect costs involved in dispensing a prescription were isolated. The cost per prescription was calculated as the total of personnel costs for dispensing plus other costs, excluding the cost of the drug. Average of 2.68 and 3.37 minutes of pharmacist and technician time, respectively, were directly involved in dispensing each prescription. The standard auxiliary times per prescription were calculated to be 1.17 minutes and 4.66 minutes for the two groups, respectively. Total pharmacy personnel time consumed in dispensing a prescription was 13.33 minutes. Total calculated personnel cost included in dispensing a prescription was +3.14. Adding to this figure other direct and indirect costs resulted in a total cost of +5.42 for dispensing a prescription. Although the time and cost figures identified are unique to this outpatient pharmacy, other institutions can use these microcosting techniques to provide data that can be useful in the negotiation of contracts for the provision of pharmaceutical services to ambulatory patients.

Costs and Cost Analysis↗
PubMed1987

Comparison of stimulants and hallucinogens on shuttle avoidance in rats.

Rats were trained to a high level of performance of a conditioned avoidance response in a shuttlebox to test effects of several classical stimulants in comparison to a variety of hallucinogens. A previously-reported biphasic pattern of effects of mescaline on shuttle avoidance was replicated and extended to 12 other hallucinogens of both phenylethylamine and indolealkylamine classes. Response patterns of hallucinogens could be differentiated from 3 stimulants and from a methoxyamphetamine compound that lacks hallucinogenic activity.

Amphetamines↗
PubMed1987

Toxicity of MDA (3,4-methylenedioxyamphetamine) considered for relevance to hazards of MDMA (Ecstasy) abuse.

Despite a paucity of data on its animal pharmacology and toxicology, MDMA [Ecstasy, XTC, ADAM; (+/-)-3,4-methylenedioxymethamphetamine] was introduced as an "underground" (FDA-unapproved) adjunct to psychotherapy in the late 1970's and early 1980's, in addition to its use as a recreational drug. Analysis of the limited experimental literature indicates that LD50's for MDMA in five species by several routes of administration tend to predict a significant human toxicity. MDMA was either equally toxic or slightly to moderately less toxic than its close congener, MDA, (+/-)-3,4-methylenedioxyamphetamine. It is suggested that extrapolation of the pharmacologic/toxicologic data available for MDA to MDMA should be assumed to be valid until disproven. Recently published canine data describe physiologic disturbances caused by acute overdosage of MDA, and also indicate the utility of chlorpromazine as an antidote preventing fatalities associated with severe hyperthermia, lactacidemia, hypertension and tachycardia. The toxicology of MDMA warrants further direct study in view of its continuing illegal distribution.

3,4-Methylenedioxyamphetamine↗
PubMed1986

An eleven-year review of the pharmacy literature: documentation of the value and acceptance of clinical pharmacy.

The primary objectives of the article were accomplished by providing both a bibliography of articles dealing with clinical pharmacy services in acute-care facilities and summaries of those constituting original research reports on clinical pharmacy services. However, in the process, we made the following interesting observations. We found that articles reporting impacts on cost, quality, and attitude numbered 48, 58, and 24, respectively. Most articles relating to drug therapy monitoring, with minor exceptions, dealt with either the quality or cost-savings impact or a combination of both. Also, articles concerning drug therapy monitoring comprised almost half of all those summarized (40 articles). Articles detailing drug information and education (category 2) numbered 28 and dealt mainly with attitudes or quality impacts with minor reference to cost-savings. It was also interesting, albeit expected, to observe that the bulk of attitudinal studies fell in category 2. We found category 5, controlling medication administration, had 13 articles, primarily concerned with cost and or quality. Category 4, reporting and detection of adverse drug reactions, contained a total of eight articles mainly studying the impact on quality. The other categories contained very few, if any, articles. From these results, it is evident that the profession has made significant strides in building a strong scientific data base to support the value of its clinical services. However, there is ample room for additional original research reports. Although it can be argued that alone many of the studies could not justify clinical pharmacy as cost-effective, organized as one reference they provide an invaluable resource. Although it might be unreasonable to expect each pharmacy department to be able to cost-justify its existence, this work presents the background data needed to begin or develop such efforts.

Bibliographies as Topic↗
PubMed1986

Microcosting method for small-volume injectables.

The costs of preparing different small-volume injectables (SVIs) in a centralized i.v. admixture pharmacy in a 650-bed teaching hospital were calculated using a microcosting method. The types of SVIs produced and methods of preparation were identified. Time-and-motion and work-sampling studies were performed to determine the amount of pharmacist and technician time spent in SVI production, auxiliary activities, and nonproductive activities. The costs of material and equipment used were calculated, and waste-cost factors based on percentages of wasted SVIs were determined. To determine the final cost per unit prepared, the calculated costs were added and multiplied by the appropriate waste factors. On the average, it took 5.57 minutes of total personnel time to prepare an SVI. It took an average of 192.4 seconds and 16.6 seconds for the technicians and pharmacists, respectively, to reconstitute a vial of powder and prepare an SVI in a minibag. Bulk prepacked items and admixtures prepared from vials of powder for reconstitution and stored in minibags were, respectively, the least and most expensive SVIs. By using microcosting methods to determine the cost of preparing SVIs, this institution discovered that the cost figures were much higher than it had anticipated. These data can be used to improve productivity and cost efficiency and to compare the costs of in-house and commercially available preparations.

Costs and Cost Analysis↗
PubMed1978

Interactions of catecholaminergic receptor blockers with lethal doses of amphetamine or substituted amphetamines in mice.

Lethality to both isolated and aggregated mice was determined for graded i.p. doses of d-amphetamine, dl-4-methoxyamphetamine (PMA), dl-2,5-dimethoxyamphetamine (DMA), dl-2,5-dimethoxy-4-bromoamphetamine (DOB), dl-2,5-dimethoxy-4-methylamphetamine (DOM) and d1-3,4-methylenedioxyamphetamine (MDA). Haloperidol (2.0 mg/kg), propranolol (10 mg/kg) and phenoxybenzamine (30 mg/kg) were tested for ability to antagonize the lethal effects of amphetamine and its derivatives. Considerable protection against amphetamine lethality was produced by haloperidol in both isolated and aggregated mice and by phenoxybenzamine in isolated mice, but propranolol was ineffective. An equivalent degree of protection was not achieved by use of any of the three agents before PMA, DMA or DOB. Protection against DOM was achieved only with phenoxybenzamine and only for isolated mice. Extensive protection against MDA was supplied by both phenoxybenzamine and propranolol for either condition of housing. Despite close structural relationships between the toxicants, the antidotal effectiveness of the receptor-blocking agents seemed quite limited and specific, and did not support any generalizations.

Amphetamines↗