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Biomedical subjects

N Sanders

Publications and source records attributed to N Sanders.

At least 19 recordsLinked to original sources
PubMed2005

Medication safety program reduces adverse drug events in a community hospital.

BACKGROUND: There is widespread interest in improving medication safety, particularly in the hospital setting. Numerous suggestions have been made as to how this should be done, but there is a paucity of data demonstrating the effectiveness of any of the interventions that have been proposed. OBJECTIVES: To assess the impact of a wide ranging, community hospital based patient safety program on patient harm as measured by the rate of adverse drug events. DESIGN: An audit of discharged hospital patients was conducted from January 2001 to December 2003. Baseline data were collected for the first 6 months and multiple drug protocols and other interventions were instituted on the nursing units and in the pharmacy department over the subsequent 9 months (transition period). These interventions were largely based on information about medication risks acquired from internal medication event reporting. Each month of the study adverse drug events (ADE) were sought from a random sample of inpatient charts. A trigger tool was used to detect clues to ADEs, the presence of which was confirmed or excluded by detailed manual chart review. The severity of these events was categorized using the classification system of the National Coordinating Council for Medication Error and Reporting and Prevention. MAIN OUTCOME MEASURES AND RESULTS: Median ADEs per 1000 doses of medication dispensed declined significantly from 2.04 to 0.65 (p<0.001). Median ADEs per 100 patient days declined significantly from 5.07 to 1.30 (p<0.001). The proportion of inpatients with one or more ADE in the baseline period was 31% and declined threefold (p<0.001). The severity of reported medication events also declined. The number of ADEs associated conclusively with patient harm was 1.67 per total doses delivered in the baseline period and declined eightfold (p<0.001). CONCLUSION: The implementation of a carefully planned series of low cost interventions focused on high risk medications, driven by information largely from internal event reporting, and designed to improve a hospital's medication safety leads to a significant decrease in patient harm.

Adverse Drug Reaction Reporting Systems↗
PubMed2003

The role of the novel D2/beta2-agonist, Viozan (sibenadet HCl), in the treatment of symptoms of chronic obstructive pulmonary disease: results of a large-scale clinical investigation.

Viozan (sibenadet HCl, AR-C68397AA) is a novel dual D2 dopamine receptor, beta2-adrenoceptor agonist, developed specifically to treat the key symptoms of chronic obstructive pulmonary disease (COPD), breathlessness, cough and sputum. The dual sensory nerve modulation and bronchodilator effects of sibenadet have been demonstrated in initial dose-ranging studies of patients with COPD and large-scale clinical evaluation has now been completed. Sibenadet efficacy was determined by assessing symptomatic changes, as defined by the novel assessment tool, the Breathlessness, Cough and Sputum Scale (BCSS). The findings of two placebo-controlled studies are reported. These multicentre, double-blind, placebo-controlled studies recruited over 2000 patients with stable COPD, randomized to receive sibenadet (500 microg) or placebo, pressurized metered-dose inhaler (pMDI) (three times daily) for a period of 12 or 26 weeks. Diary cards were completed daily by patients throughout the study to record BCSS scores, peak expiratory flow (PEF), study drug and rescue bronchodilator usage, changes in concomitant medication and adverse events. The primary endpoints were defined as change from baseline to the final 4 weeks of the treatment period in mean BCSS total score, and forced expiratory volume in one second (FEV1) measured 1 hour after administration of the final dose of study drug and expressed as a percentage of the predicted FEV1. In addition, clinic assessments were made to determine changes in pulmonary function, health-related quality of life, perception of treatment efficacy and adverse events. Despite initial improvements in mean daily BCSS total scores in patients receiving sibenadet, the difference in the change from baseline to the final 4 weeks of the treatment period between the two treatment groups was neither statistically significant, nor considered to be of clinical importance. Although marked bronchodilator activity was seen early on with sibenadet treatment, the duration of effect diminished as the studies progressed. Sibenadet use was not associated with any safety concerns. These studies, utilizing the novel BCSS, have clearly illustrated that, despite initial symptomatic improvement with sibenadet therapy, this clinical benefit was not sustained over the course of the study.

Administration, Inhalation↗
PubMed2001

A comparative study of the effects of carbamazepine and the NMDA receptor antagonist remacemide on road tracking and car-following performance in actual traffic.

RATIONALE: Antiepileptic drugs are known to produce side effects which may impair driving performance. Performance effects, however, may differ substantially between individual antiepileptic drugs. OBJECTIVE: To compare the effects of carbamazepine, remacemide, and placebo on actual driving performance during a 12-day incremental dosing regimen. METHODS: Twenty-two healthy volunteers participated in a three-way, double-blind, cross-over driving study. Treatment effects were assessed in two actual driving tests carried out on days 8, 10, and 12 of each treatment period. The Road Tracking Test involved driving an instrumented vehicle at a constant speed and steady lateral position between the delineated lane boundaries. Standard deviation of lateral position (SDLP) was measured to indicate precision of road tracking control. The Car-Following Test involved driving the same vehicle behind a leading car and maintaining that distance while the latter executed a series of deceleration/acceleration maneuvers. Time to speed adaptation (TSA) and brake reaction time were the primary measures. RESULTS: Remacemide did not affect the subjects' driving performance. Carbamazepine increased SDLP throughout treatment and lengthened TSA on day 8. Changes in SDLP relative to placebo were comparable to those previously seen in drivers conducting the same test with blood alcohol concentrations of 0.05 g/dl. CONCLUSION: Remacemide, at the given dose regimen, does not affect driving performance. Carbamazepine, at the given dose regimen, can produce mild but sufficient impairment to put epileptic patients at risk when driving, at least during initiation therapy.

Acetamides↗
PubMed2001

Interactions between oligonucleotides and cationic polymers investigated by fluorescence correlation spectroscopy.

PURPOSE: To evaluate whether fluorescence correlation spectroscopy (FCS) can be used to characterize the complexation between oligonucleotides and cationic polymers. METHODS: The features of the complexes between rhodamine labeled oligonucleotides (Rh-ONs) and poly(2-dimethylamino)ethyl methacrylate (pDMAEMA), poly(ethylene glycol)-poly(ethyleneimine) (pEG-pEI), and diaminobutane-dendrimer-(NH2)64 (DAB64) were characterized by light scattering, electrophoretic mobility, electrophoresis, and FCS. RESULTS: At low polymer/Rh-ON ratios, a decrease of the fluorescence of the Rh-ONs was observed on binding of the Rh-ONs to all cationic polymers. This was explained by the creation of "multimolecular complexes" in which the Rh-labels quench each other. The multimolecular complexes, which are highly fluorescent as they carry a number of Rh-ONs, resulted in high fluorescence peaks in the fluorescence fluctuation profile as measured by FCS. For pDMAEMA and DAB64, at higher polymer/Rh-ON ratios the fluorescence of the polyplexes increased, caused by the formation of "monomolecular complexes," which consist of only one Rh-ON per polymer. In the case of pEG-pEI, the fluorescence stayed constant when the polymer/Rh-ON ratio increased, so multimolecular polyplexes remained. FCS confirmed these results as the high fluorescence peaks disappeared in case of pDMAEMA/Rh-ON and DAB64/Rh-ON dispersions, but remained present for pEG-pEI/Rh-ON dispersions. CONCLUSIONS: FCS seems applicable for study of the interactions between ONs and different types of cationic polymers.

Cations↗
PubMed1998

Health promotion partnerships: service and education addressing the health needs of vulnerable groups.

This paper describes partnerships between service and education that can assist in meeting the health care needs of vulnerable population groups. Baccalaureate nursing students learn about population-based nursing practice as a means of addressing health needs. Each semester, groups of 8-10 senior students work with a community agency serving a population at risk. Students assess health needs and plan, implement, and evaluate a health promotion intervention with the population and the agency. Emphasis is placed on designing culturally appropriate interventions that are accomplished in partnership with the agency and population. Projects which illustrate the generalizability of this approach will be discussed. Such experiences reduce barriers that separate education from practice. Community agencies benefit as health needs that might not otherwise be met are addressed.

Alaska↗
PubMed1997

Resolution of erectile dysfunction and inhibited male orgasm in a single homosexual male and transfer of inhibited male orgasm cure to his partner: a case report.

The following case study illustrates the treatment of a single male with an erectile dysfunction as well as an inability to achieve orgasm by partner stimulation. His partner also suffered from the latter dysfunction. Although we never saw his partner, we were able to cure both dysfunctions in the patient and reportedly his partner's difficulty as well.

Adult↗
PubMed1993

Safety of lumbar puncture in patients with hemophilia.

STUDY OBJECTIVE: To determine the safety of lumbar puncture in patients with hemophilia who are pretreated with clotting factor. DESIGN: Retrospective analysis of medical records between 1980 and 1990. SETTING: Three hospitals, each serving as a regional hemophilia center. PARTICIPANTS: Thirty-three patients with hemophilia A or B who received one or more lumbar puncture. INTERVENTION: All patients received replacement of deficient factor before the lumbar puncture. Serious post-lumbar puncture complications were defined as motor or sensory deficits, incontinence, or documented intraspinal hemorrhage. RESULTS: Thirty-three patients with hemophilia A or B received a total of 52 lumbar punctures during the study period. Thirty of 33 patients (91%) had severe baseline factor deficiency, two (6%) had moderate deficiency, and one (3%) had mild deficiency. There were no serious complications reported as a result of the lumbar puncture. The 95% confidence interval for the risk of a serious complication was 0% to 5.8%. CONCLUSION: With adequate factor replacement, a lumbar puncture can be done safely in patients with hemophilia.

Adolescent↗
PubMed1991

Universal precautions: how effective are they against methicillin-resistant Staphylococcus aureus?

1. Because MRSA is commonly carried asymptomatically, colonized patients and caregivers are usually not recognized. During outbreaks, colonized and infected patients act as reservoirs and caregivers become transient carriers. 2. Because universal precautions and body substance isolation were originally developed in response to the AIDS epidemic to meet the safety needs of hospital caregivers, the use of universal precautions in extended care facilities should be further studied and refined. 3. In planning for effective training, enforcement, and compliance with universal precautions, it is essential that employees understand not only the importance of protecting themselves, but also the need to prevent cross-infection. 4. If a patient has an MRSA respiratory tract infection, the environment, including the air, may become heavily contaminated. Caregivers should wear masks to prevent nasal colonization.

Cross Infection↗
PubMed1979

Wedge resection in host cornea to correct post-keratoplasty astigmatism.

The obvious problem with surgery of this nature is that the amount of wedge to be removed is partially guess work. Doctor Troutman's keratoscope attachment to his microscope is very helpful. I have tried thermokeratoplasty in a very similar case, but the disadvantages of pain, ulceration, vascularization, and considerable return to pre-burn K readings have made me abandon this technique. If there is an obvious override, then the keratoplasty wound itself must be revised in the usual manner. However, for the present, when a graft looks perfect but the K readings reveal otherwise, a judicious wedge resection between graft and limbus (location being in the flattest meridian) would appear to be a most reasonable operation.

Astigmatism↗
PubMed1976

Marital therapy in groups. A comparative evaluation of behavioral and interactional formats.

A comparative evaluation was conducted in a community mental health center between two types of brief, marital therapy in groups. The experimental group of four couples was exposed to behavioral methods based on social learning principles. The primary interventions were (1) training the spouses in discriminating and monitoring the occurrence of pleasing events and behaviors; (2) behavioral rehearsal of communication skills using prompting, modelling, feedback, and "homework" assignments; and (3) contingency contracting. The comparison group of five couples was led in an interactional format with the leaders encouraging ventilation of feelings, problem-solving through discussion, and mutual support and feedback. Both groups were led by the same three clinicians. Outcome was measured on multiple levels before, during and immediately after treatment. Follow-up assessments were conducted at one, two, and six months after treatment. Response measures included the self report by clients on marital satisfaction; on consumer satisfaction with the treatment experience; on their observations of pleasing behaviors given and received as recorded on wrist counters; and direct observation of client via "live" time-sampling and coding of videotapes of problem-solving discussions before and after treatment. Results showed few differences between groups on the self-report measures; however, there were significant improvements by both groups on these measures after treatment which were maintained into the follow-up evaluation. The direct observational data indicated that the members in the behavioral group displayed significantly more positive and mutually supportive verbal and nonverbal behaviors in their interaction as a result of treatment.

Behavior Therapy↗