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Biomedical subjects

K Wichman

Publications and source records attributed to K Wichman.

13 recordsLinked to original sources
PubMed1995

Development of a comprehensive clinical pharmacy workload documentation system.

The purpose of this project was to develop a workload documentation system which captures the clinical activities of the pharmacist, as well as the pharmacist's impact on the patient's drug therapy outcomes and costs. The documentation system consists of three sections: clinical activities, clinical effectiveness indicators, and cost-effectiveness indicators. In addition to those established by the National Hospital Productivity Improvement Program-Pharmacy Workload Measurement System, other indicators are incorporated to more accurately reflect the pharmacists' daily clinical activities. Clinical effectiveness indicators of patient outcomes include the number and type of drug-related problems identified and resolved and the number of therapeutic interventions made and accepted. Cost-effectiveness is measured by pharmacists' interventions on 14 focused areas of drug therapy. Compliance with daily documentation is facilitated by use of pocket-sized cards for data collection and retrieval. This documentation system has been implemented since December 1990. Quarterly reports submitted to the Director identify changes and trends in workload. Information is used for staff justification, impact assessment of clinical service provided, identification of needs for staff development and planning future clinical directions. In order to enhance the efficiency of documentation and data analysis, future plans include computerization and evaluation of the frequency of data collection.

Clinical Pharmacy Information Systems↗
PubMed1993

Management considerations to implementing pharmaceutical care.

Progressing towards the goal of PC requires a fundamental change to pharmacy practice. Strong leadership and management skills will be needed to facilitate this change. Even with enthusiastic and capable staff, implementation of the PC model will require considerable effort. Changes to the department's mission statement and organizational structure will be required. From this beginning, an action plan for the department can be developed. This plan includes the training of individuals and/or recruiting the necessary personnel. An ongoing education program, as well as determining the value of your service, is required. With successful implementation the PC model will lead to the acceptance of the pharmacist's role as the person responsible for identifying, preventing, and resolving drug-related problems.

Canada↗
PubMed1988

Intrauterine exposure to the beta-adrenergic receptor-blocking agent metoprolol and allergy.

Cord blood IgE levels and the development of allergy were studied in 29 children born by mothers who had been treated with the beta-adrenergic receptor blocking agent, metoprolol, during the pregnancy and in 23 children of placebo-treated mothers. In 13 (45%) of the former and 3 (15%) of the placebo group elevated cord blood IgE levels, i.e. more than 0.9 kU/l and/or obvious or probable allergy developed (p = 0.03). The findings support previous experimental observations that beta-blocking agents may enhance IgE antibody formation. It also adds to the number of environmental factors that may increase the risk for atopic disease in children.

Double-Blind Method↗
PubMed1986

Blood pressure and renal function during normal pregnancy.

In order to obtain reference values during normal pregnancy 24 women with strict criteria for health and normal pregnancy were studied. Greatest interest was focused on blood pressure (BP) measurements and renal function tests. Investigations were made in early second trimester and in the 30th, 33rd and 36th gestational weeks. Gestational age was estimated by ultrasound measurement of crown-rump length before the 14th gestational week. Both systolic and diastolic BP measured in the right arm were about 10 mmHg lower in the left lateral position than when supine or standing. The difference is suggested to be dependent on hydrostatic factors. Diastolic BP should be defined at the fourth phase of the Korotkoff sounds in order to be reliable because of the common phenomenon of late or non-disappearance of the sounds during pregnancy. Diastolic BP in phase IV increased in up to 25% of the cases with 15 mmHg or more from early second trimester to the 36th gestational week in all three positions. Serum creatinine concentration was low in early second trimester and did not change during pregnancy, while serum urea decreased and serum urate increased during pregnancy. The results emphasize the importance of using reference values from a normal pregnant population obtained at different gestational weeks for comparison in studies on certain pathological conditions during pregnancy, especially pre-eclampsia.

Adult↗
PubMed1985

Hydrolysis of phospholipid monolayers by human spermatozoa. Inhibition by male contraceptive gossypol.

Monomolecular films of phospholipid were used to study the interaction of intact human spermatozoa with model membranes. Exclusively with negatively charged phosphatidylglycerol monolayers rapid penetration of spermatozoa into the monolayer with subsequent hydrolysis of the lipid was triggered by the addition of 5 mM calcium into the medium. The results suggest the localization of a calcium-dependent phospholipase A2 at the outer acrosomal or plasma membrane of human spermatozoa with its active site exposed to the external environment. Preincubation of the cells with 100 microM gossypol completely abolished the ability of human spermatozoa to hydrolyze or penetrate monolayers of phosphatidylglycerol. The inhibition of the phospholipase activity by gossypol may contribute to the unknown contraceptive mechanisms of this non-steroidal male antifertility agent.

Gossypol↗
PubMed1984

Screening for detection of intra-uterine growth retardation by means of ultrasound.

In a two-stage ultrasound screening program the gestational age was assessed by measurement of the fetal crown-rump length in early pregnancy. At an adjusted gestational age between 32 and 35 completed weeks the biparietal diameter, the abdominal circumference, the abdominal area and the ratio between fetal head area and abdominal area were estimated by means of ultrasound measurement. 'Acute' fetal weight was estimated by calculations from biparietal diameter and abdominal diameters. Percentile curves were constructed for these parameters and cut-off limits were tested for the predictability of intra-uterine growth retardation of the fetus. The abdominal circumference and area estimations were equally good for the detection of intra-uterine growth retardation. The biparietal diameter alone is of limited value for the detection of intra-uterine growth retardation but the combination with abdominal diameters in 'acute' fetal weight estimation can well be used. The ratio between the skull and abdominal areas seems to be of little use for the detection of intra-uterine growth retardation of two reasons: difficulty in measurement and low sensitivity. We consider that the assessment of gestational age in early pregnancy is a necessity both for the identification of suspected IUGR by means of ultrasound and the diagnosis of IUGR by measurement of fetal weight at birth. It is concluded that if the gestational age has been assessed by crown-rump length measurement in early pregnancy, a single estimation of the fetal abdominal circumference between 32 and 35 completed gestational weeks and a cut-off limit at the 15th percentile offers a detection rate of about 90% of the growth retarded infants.

Abdomen↗
PubMed1984

Changes in the renin-angiotensin-aldosterone and kallikrein-kinin systems during normal and hypertensive pregnancy.

We conducted a prospective and serial study of blood pressure (BP) and of the changes in the renin-angiotension-aldosterone system (RAAS) and of one factor in the kallikrein-kinin system during normal pregnancy and in patients with pre-existing or developing hypertension in pregnancy. Strict diagnostic criteria were used to define pre-eclampsia (PE), essential hypertensives (EH) and other hypertension (OH) in pregnancy. In normotensive pregnant women (n = 26) there was a rise in all components of the RAAS measured: plasma renin activity (PRA), plasma aldosterone concentration (PAC) and urinary aldosterone excretion (tU-Aldo), from week 12 to week 20 of pregnancy, compared with non-pregnant control subjects (n = 24) of similar age. Peak values were observed at week 30, whereafter fairly constant levels were maintained. Plasma and urinary aldosterone levels were increased 6-10 fold. Urinary kallikrein excretion (tU- Kall ) was increased at weeks 12-20, but at weeks 30-36 roughly the same mean values were observed as for non-pregnant control subjects. On the other hand, different results were obtained in the hypertensive patients, especially those with PE (n = 18). PRA was depressed in the PE group to values about those observed in non-pregnant control subjects. PRA was also significantly lower in the PE group than in EH (n = 8) or OH (n = 16) groups. PAC and tU-Aldo were also much lower in PE patients than in normal pregnant women at comparable gestational ages, but not significantly different from EH patients, whereas those with OH had both PAC and tU-Aldo values comparable to normal pregnant women.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1984

The influence of different positions and Korotkoff sounds on the blood pressure measurements in pregnancy.

The influence of the patient's posture on the measurement of arterial blood pressure has been studied during pregnancy. The blood pressure (BP) measured on the right arm in the left lateral recumbent position is significantly lower than in the supine, sitting, or erect positions. This difference is assumed to be due to hydrostatic factors. The diastolic BP should be read off at Korotkoff IV because the hyperkinetic circulation during pregnancy causes a pronounced variation in BP values when measurements are performed at Korotkoff sound V. The roll-over test seems inappropriate as a screening test to predict pre-eclampsia, because of the numerous false-positive tests. The importance of measuring the BP under standardized conditions during pregnancy in order to detect minimal changes in BP as indicative of pathophysiology in pre-eclampsia is emphasized.

Blood Pressure↗
PubMed1984

Neonatal effects of beta-blocking drugs in pregnancy.

A review is presented as regards the neonatal effects of beta-blocking agents in hypertension during pregnancy. Experience points to low fetal and neonatal risks, but firmly based data concerning the neonates are very scanty. An on-going double-blind study is presented in which pregnant women with hypertension are randomly allocated to either metoprolol or placebo treatment. One of the aims is to study the postnatal adaptation of the infants. The following measurements, recordings and examinations are performed: anthropometric measurements, Apgar score, blood gases and acid-base status in umbilical (venous and arterial) blood, lactate and hypoxanthine in umbilical venous blood, catecholamines in umbilical arterial blood, pulse rate, blood glucose and a quantitative neurobehavioral assessment in the neonatal period.

Adrenergic beta-Antagonists↗