Biomedical subjects

S L Follin

Publications and source records attributed to S L Follin.

5 recordsLinked to original sources

PubMed2000

Enhancement of a pharmacy consultation program on a transitional care unit.

The revision and outcomes of a pharmacy consultation program on a transitional care unit (TCU) are described. In 1996, the pharmacy consultation program for the TCU at a 550-bed, tertiary care, community teaching hospital was revised. The changes included increasing the number and depth of medication reviews, mandating pharmacist attendance at interdisciplinary meetings, simplifying the medication review form, and expanding physician education. Data collected during the final two years of the original program (May 1994 to April 1996) and the first two years of the revised program (July 1996 to August 1998) were compared. The number of drug-related problems identified per admission was 0.80 for the revised program (versus 0.32 for the original program), the percentage of patients receiving at least one pharmacy medication review was 99% (versus 70%), the number of pharmacist recommendations made was 726 (versus 140), and the percentage of recommendations accepted was 82% (versus 55%). The program required up to 15 hours of pharmacist time per week. Cost savings were estimated at $15,000 for the first year of the revised program and $23,000 for the second year. Revision of the pharmacy consultation program for a TCU increased the identification of drug-related problems and the number of pharmacist recommendations, helped integrate pharmacists into the interdisciplinary care team, and produced a modest estimated cost savings.

Data Collection↗

PubMed1997

Acute pain management: operative or medical procedures and trauma.

OBJECTIVE: To review the topics presented in the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guideline for Acute Pain Management and provide updated information on therapeutic issues as necessary. DATA SOURCES: AHCPR Clinical Practice Guideline for Acute Pain Management: Operative or Medical Procedures and Trauma. A MEDLINE search (1990 to June 1996) of English-language literature pertaining to pain assessment and management was performed. Reference lists from relevant articles also served as a literature source. STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated. Relevant information, as determined by the authors, was included in the review. DATA SYNTHESIS: Inadequate acute pain management continues to be recognized as a problem due to limited health professional education on the treatment of pain, inadequate patient empowerment, negative connotations associated with opioid analgesics (e.g., fear of "addiction"), federal regulations associated with prescribing opioid analgesics, and difficulty in assessing pain. The widespread inadequacy in pain management prompted the development of the AHCPR Clinical Practice Guideline for Acute Pain Management, which was published in 1992. In addition to reviewing the pain guideline, this article includes updated information on ketorolac tromethamine, tramadol, local anesthetics, sedation, regional anesthetic techniques, and the management of opioid adverse effects. CONCLUSIONS: The AHCPR Clinical Practice Guideline for Acute Pain Management is a comprehensive, yet functional, review for clinicians. Most issues relating to acute pain assessment and management are adequately discussed. Overall, this guideline is a worthwhile general resource to clinicians. It is important, however, for clinicians managing acute pain issues to supplement this guideline with more detailed and current information.

Analgesics↗

PubMed1996

Falsely elevated serum vancomycin concentrations in hemodialysis patients.

Fluorescence polarization immunoassay (FPIA) is the most widely used clinical vancomycin assay in the United States. Questions exist regarding the accuracy of this polyclonal assay in patients with end-stage renal disease (ESRD). While several studies have reported discrepancies in vancomycin serum concentrations determined by FPIA compared with other vancomycin assays, no study has investigated the accuracy of vancomycin serum concentrations determined by FPIA in patients with ESRD undergoing maintenance hemodialysis. Therefore, we compared the assay performance of FPIA and enzyme multiplied immunoassay technique (EMIT) in six subjects with ESRD receiving high-efficiency hemodialysis. Subjects underwent 6 consecutive weeks of hemodialysis treatment with a cellulose acetate dialyzer (CA210) and received 1 g vancomycin intravenously once weekly during the last hour of dialysis. Vancomycin serum concentrations were determined by both EMIT and FPIA methodologies. From the serum concentration results of both assays, vancomycin dosing recommendations were calculated to achieve a desired steady-state peak concentration of 35 mg/L and trough concentration of 10 mg/L. Overall, vancomycin serum concentrations reported by FPIA were significantly higher than those reported by EMIT. The mean difference between assays in the peak serum concentrations at weeks 1, 4, and 6 was 7.5, 11.5, and 11.2 mg/L, respectively. The mean difference in trough serum concentrations at weeks 1, 4, and 6 was 4.2, 6.2, and 5.2 mg/L, respectively. The FPIA overestimation of the EMIT values (calculated as FPIA-EMIT) varied widely among study subjects with a range of 0.0 mg/L to 27.0 mg/L for peak serum concentrations and 0.0 mg/L to 12.8 mg/L for trough serum concentrations. The mean doses calculated based on FPIA results were significantly lower than the EMIT-derived doses. No significant difference was observed in the calculated dosing intervals. These results demonstrate that FPIA significantly overestimates vancomycin serum concentrations compared with EMIT in patients with ESRD undergoing high-efficiency hemodialysis. The overestimation by FPIA may result in significantly different vancomycin dosing recommendations, leading to underdosing and the potential for therapeutic failures. Due to the unpredictability of the overestimation by FPIA, we were unable to formulate vancomycin dosing guidelines for institutions that use FPIA. Therefore, we recommend that the EMIT vancomycin assay be used in patients with ESRD to ensure appropriate dosing.

Adult↗

PubMed1995

Risk factors for the development of specific noncardiovascular adverse effects associated with amiodarone.

Noncardiovascular adverse effects associated with amiodarone result in substantial morbidity. Adverse effects involving the skin, liver, thyroid, and lungs have been reported in as many as 57%, 55%, 11%, and 13% of patients, respectively. Although risk factors for some amiodarone-induced adverse effects have been identified, risk factors for these specific side effects have not been systematically evaluated. Therefore, risk factors for development of amiodarone-induced dermatologic, hepatic, thyroid, or pulmonary adverse effects were identified using univariate analysis in 44 patients receiving the drug for supraventricular or ventricular arrhythmias (mean duration of therapy 99.5 +/- 110.8 weeks). Dermatologic side effects occurred in 4 (9.1%) patients. Patients who experienced dermatologic side effects were younger than patients who did not (mean age, 48.3 +/- 15.8 years versus 60.1 +/- 9.5 years, respectively; P = .03). Patients younger than 60 years of age were more likely to develop photosensitivity or blue-gray skin discoloration than those aged 60 or older (P = .05). Hepatic adverse effects occurred in 3 (6.8%) patients. Left ventricular ejection fraction was lower in those who developed hepatic adverse effects than in those who did not (15.0 +/- 4.0% versus 39.1 +/- 13.9%, P = .005). Adverse thyroid effects occurred in 6 (13.6%) patients; and pulmonary fibrosis occurred in 2 (4.5%) patients. No specific risk factors for adverse thyroid effects or pulmonary fibrosis were revealed. In conclusion, age less than 60 may be a risk factor for amiodarone-induced dermatologic adverse effects, whereas severely depressed left ventricular ejection fraction may be a risk factor for hepatic side effects associated with amiodarone.

Adult↗

PubMedDate not supplied

Second-generation antihistamines: the OTC debate.

OBJECTIVE: To demonstrate that the safety profiles of second-generation antihistamines (SGAs) meet the criteria set by the Food and Drug Administration (FDA) for switching these products to over-the-counter (OTC) status. DATA SOURCES: MEDLINE search of articles published from 1970 through 2000. SUMMARY: Most patients with allergic rhinitis treat their symptoms with first-generation antihistamines (FGAs), which are available over-the-counter (OTC). Yet FGAs are generally considered less safe than the newer drugs. FGAs cause central nervous system (CNS) adverse effects and may increase users' risk for work-related injuries and motor vehicle accidents and, in children, for learning impairment. SGAs cause fewer CNS effects, do not appear to affect learning in children, and do not have significant drug interactions. Several other countries have made SGAs available OTC. Blue Cross of California petitioned FDA in July 1998 to make this class of drugs available OTC in the United States. This petition will finally be heard in May 2001. The 1951 Durham-Humphrey amendment to the original Federal Food, Drug and Cosmetic Act of 1938 requires that "a drug be made available without a prescription if, by following the labeling, consumers can use it safely and effectively without professional guidance." If judged according to this and other criteria promulgated by FDA, SGAs should be strongly considered for being switched to OTC status. CONCLUSION: The safety and efficacy of SGAs have been adequately established. Consumers should have the option of self-treating mild allergic rhinitis symptoms with these products.

Histamine Antagonists↗