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Biomedical subjects

R Segal

Publications and source records attributed to R Segal.

At least 271 records · Page 15Linked to original sources
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Therapeutic outcomes monitoring: application of pharmaceutical care guidelines to community pharmacy.

OBJECTIVE: To design a pharmaceutical care model, and develop and field test a set of community pharmacy guidelines and practice support materials--Therapeutic Outcomes Monitoring (TOM) modules. DESIGN: Concept interviews with pharmacists, physicians, and patients; development and field testing of practice guidelines. SETTING: Community pharmacies. PARTICIPANTS: Five independent, five chain, and two clinic site pharmacies. INTERVENTIONS: A prototype TOM module for asthma was developed through a seven-step process. Concept interviews were held with pharmacists, physicians, and patients to determine the desirability and feasibility of the TOM concept, prototype, and materials. Two field tests were completed and modifications made. Results were gathered through further concept interviews at the completion of the second field tests. MAIN OUTCOME MEASURES: Participants' opinions and experiences. RESULTS: Pharmacists, physicians, and patients expressed favorable attitudes about community pharmacists' participation in this pharmaceutical care model. Of the 12 participating pharmacists, 7 successfully implemented TOM in their practice sites and participated in the project throughout the testing; 49 patients were recruited into the study; and 22 patients remained in the program at the end of the second field test. In providing TOM services to these patients, the two most problematic areas for the pharmacists were in documenting care and reporting to physicians. A final phase of the TOM project has not been conducted in the United States because of insufficient numbers of patients for evaluating patient outcomes. CONCLUSION: The TOM project was successful from a technical but not a marketing perspective. Useful practice guidelines can be written and taught to pharmacists. Enrollment of patients was difficult, and the concept is not likely to spread spontaneously within the existing market for pharmaceutical services.

Asthma↗
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Barium enema in frail elderly patients.

BACKGROUND: Barium enema (BE) examinations for the investigation of suspected colonic disease are often unsuccessful in elderly patients. OBJECTIVE: The purpose of this study was to evaluate the success rate of BE in hospitalized frail elderly patients. METHODS: Four hundred and seventy-two elderly patients hospitalized for different reasons underwent BE examinations. The medical charts and radiological reports were retrospectively reviewed. RESULTS: One hundred and ninety-two (41%) BE examinations were considered inadequate; mostly (32%) because of inappropriate preparation. Sixty-seven patients (14%) were not cooperative and could not retain the contrast material, and in 25 patients (5%), the examination failed due to both these reasons. The characteristics associated with unsuccessful BE examination were the mean number of medical problems (p < 0.001), the mean number of scheduled medications (p < 0.05) and in particular the long-term use of laxatives (p < 0.01) or antiparkinsonian drugs (p < 0.01). Of great significance in predicting an inadequate BE were the patient's functional status (p < 0.001) and the presence of dementia (p < 0.001). CONCLUSIONS: The high percentage of unsuccessful BEs in the frail elderly suggests that clinicians should carefully consider the need for that examination in these patients. We suggest that only in patients where there is a clear suspicion of a bleeding or obstructing tumor should a BE examination be performed, and even in these cases, colonoscopy or CT may be preferable as the initial examination in the frail elderly.

Aged↗
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Needs assessment and the cardiac rehabilitation patient. A focus on medication teaching.

The findings of this study indicate that both cardiac patients and health care providers view information about medications to be important in cardiac rehabilitation programs. Although most medication topics were perceived by the patients to be complete, the completeness of several important medication topics was rated as only fair or poor.

Adult↗
PubMedDate not supplied

Impact of a clinical pharmacist on antibiotic prescribing. A multicenter trial.

Within the past two decades, hospital pharmacists have become increasingly involved in providing consultation to physicians for drug management. Antibiotic use has become a complex and rapidly expanding discipline, complicated by the introduction of multiple new antimicrobial agents, each with unique features, and the pressures of prospective payment schemes. This study demonstrated that a team including a pharmacist had a positive impact on medical residents' utilization of antibiotics.

Adult↗
PubMedDate not supplied

Adaptive strategies of mothers with children with attention deficit hyperactivity disorder: enfolding and unfolding occupations.

OBJECTIVE: To describe adaptive strategies of time use among mothers with children with attention deficit hyperactivity disorder (ADHD) and, in particular, the adaptive strategies of unfolding occupations that were commonly used by these mothers. METHOD: In-depth interviews were conducted with 17 families with children with ADHD. Parents were asked to describe their family's daily schedule, routines, and how occupations were performed. Data were analyzed using the grounded theory approach. FINDINGS: Mothers used three adaptive strategies: enfolding occupations, temporal unfolding of occupations, and unfolding occupations by inclusion. Enfolding occupations means performing more than one occupation at a time. Unfolding occupations means taking chunks of activities or occupations out of previously established sequences of enfolded occupations to be performed at a different time (temporal unfolding) or by a different person (unfolding by inclusion). The child's special needs and the availability of financial and human resources influenced the selection of adaptive strategy. Using these adaptive strategies enabled the mothers to care for their children. However, using enfolding or temporal unfolding meant that mothers had less time for other occupations. CONCLUSION: The benefits and limitations of the adaptive strategies of enfolding and unfolding occupations suggest a need to study time use in different contexts. Before suggesting use of these adaptive strategies by parents of children with special needs, therapists need to be aware of the family's financial and human resources.

Adult↗
PubMedDate not supplied

Restrictive lung disease due to diaphragmatic dysfunction in systemic lupus erythematosus. Two case reports.

Two patients with systemic lupus erythematosus and unexplained dyspnea are described. Both had severe dyspnea and a restrictive lung function pattern without any apparent specific pathology. Both patients initially responded to corticosteroids and/or immunosuppression; one patient, however, relapsed and eventually died. Many factors may contribute to this syndrome, including diaphragmatic dysfunction, splinting of the diaphragm, pleuritis, atelectasis and respiratory muscle dysfunction. This syndrome, which may respond to steroids or immunosuppressive treatment, must be considered in SLE patients with dyspnea lacking a concrete underlying cause.

Adult↗