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Biomedical subjects

R J Michocki

Publications and source records attributed to R J Michocki.

18 recordsLinked to original sources
PubMed1993

Drug prescribing for the elderly.

Both the geriatric population of the United States and the use of prescription drugs by this age group continue to increase. Cardiovascular medicines, analgesics, anti-inflammatories, and psychotropic medications are used most commonly. Polypharmacy, defined as a condition in which a patient receives too many drugs, drugs for too long, or drugs in exceedingly high doses, often results.

Aged↗
PubMed1992

The clinical use of histamine-2 receptor antagonists.

Histamine-2 receptor antagonists have been available for fifteen years for the treatment of peptic ulcer disease and related disorders. While very safe, clinicians need to know correct dosing guidelines, drug interactions, and side effect profiles. Long-term therapy should be reserved for patients at high risk of recurrence.

Cimetidine↗
PubMed1990

Alternate drugs.

It is important to consider a number of factors when deciding on drug therapy for elderly patients. The principles of efficacy, side effect profile, ease of administration, interaction with other drugs or concomitant illness, cost, and constant reevaluation of the need for continued treatment should be remembered for any treatment. In many cases the ideal drug may be initially no drug at all. A number of alternative drugs are available for most conditions, and the drug of choice for the elderly may actually be one of these alternative agents. We have attempted to consider these basic principles as they may be applied in making a decision for ideal drug therapy and for alternative therapies for elderly patients.

Aged↗
PubMed1988

Medication management.

The elderly receive more drugs than any other patient group, and those in nursing homes receive the most. However, little is known about drug action, particularly in the very old. A host of factors can alter drug action. Particular attention needs to be paid to the influence of intercurrent disease, other drugs in a particular regimen, the patient's weight and nutritional status, as well as altered pharmacokinetic and pharmacodynamic characteristics of any drug. Liver and kidney status, and changes therein, are most important.

Aged↗
PubMed1984

Drug prescribing for ambulatory patients 85 years of age and older.

Drug prescribing for ambulatory patients greater than or equal to 85 years of age was studied using data from the 1980 National Ambulatory Medical Care Survey (NAMCS) on office visits to physicians. NAMCS is a survey by the US National Center for Health Statistics, which collected information on office visits and extrapolated the results to the US population. Of the 575.7 million office visits by all ages, 6.8 million (1 per cent) were by persons greater than or equal to 85 years of age, and 64 per cent involved females. Ninety per cent of the total office visits of those greater than or equal to 85 years were with a physician who had seen them before; 94 per cent were with MDs as compared with DOs; 56 per cent were with general practitioners or internists; and 95 per cent had some type of follow-up planned. The most frequent duration of the office visit was 11-15 minutes (36 per cent). The most frequent diagnostic class was diseases of the circulatory system. The survey physicians were asked to list all drugs, new or already in use by the patient, that were ordered, administered, or prescribed during the visit. The authors converted the drug brand names to their nonproprietary or generic name component(s); each active ingredient of combination products was treated as a separate drug entity. All drug analyses used generic names. Thirty-two per cent of visits did not involve the use of any drug, 21 per cent involved one drug; 12 per cent, two drugs; and 16 per cent, three drugs. Cardiovascular-renal drugs were the most frequently mentioned. One-third of the visits involved the use of one or more drugs that have psychologic effects, either intended or as side effects. Three per cent of the office visits involved the use of two or more drugs that had the potential for clinically important interactions.

Age Factors↗
PubMed1976

The care of decubitus ulcers pressure sores.

Despite a large volume of literature particularly directed toward treatment, pressure sores (including decubitus ulcers) remain a difficult problem, especially in the nursing home environment. The treatment of pressure sores is somewhat controversial and quite diversified. Selection of a successful therapeutic modality must be preceded by correct evaluation, i.e., whether the sore is superficial or deep, open or closed. The treatment of superficial sores is conservative and directed toward cleanliness, relief of pressure, and exposure to air. Surgical debridement may be indicated. Proteolytic enzymes often are employed as adjunctive therapy, although there are some major drawbacks to their use. The plethora of therapeutic agents suggested for the treatment of deep pressure sores probably is related to the difficulties in achieving success. Surgical debridement is indicated, and proteolytic enzymes are widely used. Possible interactions. and factors leading to the inactivation of these enzymes are discussed, as is the use of various solutions, ointments, gold leaf, oxygen, dry heat, and other adjunctive devices. Of paramount importance in the management of pressure sores is the maintenance of cleanliness and dryness.

Administration, Topical↗
PubMed1976

The problem of pressure sores in a nursing home population: statistical data.

This study on 93 patients was conducted at a skilled nursing facility. Twenty-two of the 93 patients had pressure sores; 34 of the 54 sores were present when the patients were admitted and 20 developed after admission. Only 5 of the 54 sores healed. Healing times ranged from 15 to 55 days after the beginning of treatment. Thirteen deaths occurred among the 71 patients without sores, and 17 deaths among the 22 patients with sores. Specific treatment regimens varied (cleaning solutions, antimicrobial drugs, heat, enzymatic debridement) but always included frequent changes in the position of the patient. Ten of the 22 patients with sores were anemic vs. 19 of the 71 patients without sores. Half of the patients with sores were maintained with tube feedings whereas more than half of the patients without sores received regular house diets. Pressure sores are a serious problem among geriatric patients in nursing homes. All those who care for the aged should be fully aware of the procedures involved in the prevention and management of these sores.

Adult↗
PubMedDate not supplied

Heparin requirements in pulmonary embolism and venous thrombosis: a prospective study.

To investigate the relationship between the clinical diagnosis of thromboembolic disease and heparin requirements for anticoagulation, we prospectively studied 31 patients suspected to have either deep vein thrombosis or pulmonary embolism. Six had the diagnosis of pulmonary embolism confirmed by a combination of ventilation and perfusion scans with pulmonary angiography, eight had venograms showing deep vein thrombosis, seven had diseases which mimicked pulmonary embolism, and ten had normal venograms. These four diagnostic groups were not significantly different with respect to heparin requirements during the first 24 hours of therapy (mean +/- S.D. = 426 +/- 105, 507 +/- 105, 434 +/-79, and 457 +/- 46 units/kg per 24 hours, respectively). Patients with pulmonary embolism and deep vein thrombosis did not differ significantly with respect to heparin requirements (UNITS/kg per 24 hours) on the second (386 +/- 108 vs. 439 +/- 127), third (415 +/- 136 vs. 464 +/- 130), and fourth (374 +/- 104 vs. 418 +/- 127) days of therapy. Our data suggest that the clinical diagnosis does not affect the dose of heparin necessary to anticoagulate patients with pulmonary embolism and deep vein thrombosis.

Adult↗