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Biomedical subjects

John A Armitstead

Publications and source records attributed to John A Armitstead.

8 recordsLinked to original sources
PubMed2006

Enhanced pharmacy training for counter-terrorism and disaster response.

State and federal authorities in the USA have identified pharmacists as important in terrorism detection activities. However few pharmacists are trained for disaster response planning, or providing services at disaster sites. A distance training programme was created by the College of Pharmacy at the University of Kentucky, Chandler Medical Center (UKCMC) in collaboration with an academic Medical Center, urban and rural community pharmacists, experts in pharmacy and infectious disease, and two state pharmacy associations. There was a substantial improvement in bioterrorism training knowledge as judged by pre- and post-test results. During two years of training, a total of 142 licensed pharmacists received certification (approximately 4.7% of all those in Kentucky). In addition, a network of bioterrorism-trained pharmacists was created for the state.

Bioterrorism↗
PubMed2004

Drug costs and bacterial susceptibility after implementing a single-fluoroquinolone use policy at a university hospital.

The University of Kentucky Hospital investigated the feasibility of choosing a sole fluoroquinolone for its formulary in an effort to reduce costs without affecting clinical outcomes. A three-step process was used to plan, implement, and monitor the selection program. Based on the range of clinical indications, safety profile, local susceptibility, cost, and dosing convenience, levofloxacin was chosen over ciprofloxacin and gatifloxacin as the sole fluoroquinolone. Since the implementation of the program in May 2001, susceptibility to levofloxacin has been maintained or increased for the most common pathogens. In addition, University Hospital has saved nearly 100,000 dollars in antibiotic acquisition costs during the first 12 months after the switch. This assessment did not take into account effects in clinical outcomes, such as clinical failures (such as readmission rates), mortality, and adverse events, or measure changes in overall medical expenditures beyond drug acquisition costs. In the future, monitoring of overall patient care and medical care costs, in addition to susceptibility patterns and drug costs, will allow for a better understanding of the long-term benefits of this switch.

Anti-Bacterial Agents↗
PubMed2003

Evolution and operation of a pharmacy residency on-call program.

A pharmacy residency on-call program designed to contribute to residents' competence in patient care and to extend the functions of the pharmacy department is described. The program, which was begun at the University of Kentucky Chandler Medical Center in 1984, offers a supportive environment in which the resident is held accountable for pursuing optimal outcomes of drug therapy. The program provides opportunities for the resident to engage in independent decision-making, care for a wide variety of patients, and manage acute illness. On-call services are provided in single 24-hour shifts beginning at 0800 each day. Residents assess and respond to supratherapeutic serum drug concentrations, perform pharmacokinetic monitoring, provide drug information, evaluate patients for specific drug therapy, obtain medication histories for HIV-seropositive patients, and participate in emergency patient management. Residents provide services in the absence of the primary pharmacist on nights, weekends, and holidays and devote a four-hour period to drug distribution. Each pharmacy resident participates in the on-call program, regardless of the chief focus of his or her residency. Residents' activities are documented electronically, and preceptors give feedback via e-mail. The program and its activities have evolved over the years to reflect changes in pharmacy practice. An on-call program for pharmacy residents provides a valuable learning experience while enhancing patient care.

Education, Pharmacy, Graduate↗
PubMed2003

A retrospective evaluation of vitamin K1 therapy to reverse the anticoagulant effect of warfarin.

STUDY OBJECTIVE: To assess compliance with the 2001 consensus guidelines of the American College of Chest Physicians (ACCP) regarding administration of vitamin K1 to reverse the anticoagulant effect of warfarin. DESIGN: Retrospective chart review. SETTING: University teaching hospital. PATIENTS: Fifty-five adult inpatients who received both warfarin and vitamin K1 between September 2001 and January 2002. MEASUREMENTS AND MAIN RESULTS: The patients' medical records were evaluated; data were collected on patient demographics and on vitamin K1 dosage and route of administration, warfarin dosage, and international normalized ratio (INR) before and after vitamin K1 administration. Administration routes and 87 doses of vitamin K1 prescribed for the 55 patients were assessed for compliance with the ACCP guidelines. Administration routes were subcutaneous (40.2% of doses), intravenous (35.6%), oral (13.8%), and intramuscular (10.3%). The most frequently prescribed dose of vitamin K1 was 10 mg (32.2%), followed by 2 mg (21.8%) and 5 mg (18.4%). Rates of compliance with the ACCP guidelines categorized by INR value were as follows: INR below 5, 12.2%; INR 5-9, 27.8%; INR between 9 and 20, 26.7%; and INR above 20, 0%. Four patients had documented episodes of bleeding and received seven doses of vitamin K1. Twenty-six patients received fresh frozen plasma with vitamin K1. Overall compliance with ACCP-recommended doses and routes of vitamin K1 was only 17.2%. CONCLUSION: The most frequently prescribed administration routes for vitamin K1 were subcutaneous and intravenous, indicating that the oral route is often not used as recommended. The vitamin K1 doses prescribed for reversal of warfarin anticoagulation were highly variable, and for most (83%) patients, the recommended guidelines were not followed. The clinical significance of noncompliance with the ACCP guidelines for vitamin K1 administration warrants further study.

Anticoagulants↗