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Biomedical subjects

T P Reinders

Publications and source records attributed to T P Reinders.

14 recordsLinked to original sources
PubMed1997

An overview of types of relationships between hospitals and colleges/schools of pharmacy.

Three vignettes describe the details of each of the three types of practice-education relationships in academic hospitals identified in a survey by the University HealthSystem Consortium. The educational affiliation at Penn State's Hershey Medical Center, the affiliated relationship of the Medical College of Virginia, and a fully integrated relationship at the University of Illinois at Chicago are described by the Director of Pharmacy at each institution. The advantages, disadvantages, and future goals are described.

Education, Pharmacy↗
PubMed1990

Cost and acceptability of three syringe-pump infusion systems.

The fiscal impact and acceptability of implementing a syringe-pump infusion system at a 900-bed university teaching hospital where the minibag system has been in use is reported. Researchers selected three models of syringe pumps for evaluation: the Bard Harvard Mini-Infuser 150XL, the Becton Dickinson 360 Infuser, and the Strato Stratofuse System. Each pump was evaluated for three weeks on a medical-surgical unit and a hematology-oncology unit. Drugs to be infused were chosen after a literature review to determine which drugs had been successfully infused via syringe pump; 22 formulary medications were selected. Syringes were prepared as singly packaged doses or as doses prepared in bulk and packaged frozen. Control of the syringe pumps and microbore tubing was assigned to the inpatient pharmacy staff. Nurses and pharmacy personnel were apprised of the study and taught how to use the syringe pumps. Time-and-motion studies were performed in the sterile products preparation area, and a cost analysis was done. Nurses preferred syringe pumps over the minibag system because the pumps reduced the nursing time needed to infuse a drug, administered less fluid, provided consistent infusion rates, had alarms, and were relatively easy to use. The time required to prepare syringes did not differ substantially among syringe-pump models. It was estimated that using any of the evaluated pumps in place of the minibag system would save $126,500 during the three-year period 1988-91, primarily because of differences in the cost of disposable items. The syringe-pump infusion system is an acceptable and cost-effective alternative to the minibag system.

Costs and Cost Analysis↗
PubMed1988

Economic consequences of two drug-use control systems in a teaching hospital.

Length of stay (LOS), total cost per admission (TCA), and pharmacy cost per admission (DCA) were determined for two drug-use control systems in a 1058-bed university hospital; a centralized unit dose drug distribution system served as a control. The two study systems were (1) pharmacist monitoring of drug therapy in the patient-care area and (2) centralized pharmacist monitoring of computerized patient profiles. LOS data were collected retrospectively for 659 patients admitted during a seven-month control interval. LOS, TCA, and DCA data were collected prospectively for 496 patients admitted during a five-month experimental interval. Each study system was assigned to one of three teams making rounds among intact patient groups. LOS differences were compared between intervals and by month. After corrections were made for differences in patient mix, the drug-use control system in which pharmacists were assigned to the patient-care area yielded a 1.5-day-shorter average LOS, $1293 lower average TCA (p less than 0.05), and $155 lower average DCA than under the unit dose system. The drug-use control system in which pharmacists were assigned to monitor patients' drug therapy from a central location was associated with a 0.13-day-shorter average LOS, $235 lower average TCA, and $55.13 lower average DCA than under the unit dose system. No systematic differences between teams, other than drug-use control system, appeared to explain the differences in LOS, TCA, and DCA. A drug-use control system based in a patient-care area, overseen by clinically experienced pharmacists, may result in shorter LOSs and lower total costs than centralized systems for general-medical inpatients of teaching hospitals.

Contraceptives, Oral, Combined↗
PubMed1988

Cost analysis of a home intravenous antibiotic program.

A cost analysis of a home intravenous antibiotic program was performed, and the feasibility of the program was evaluated. All fiscal data related to the antibiotic therapy of the 10 study patients were collected from the patients' billing records and charts. Inpatient charges for antibiotics, supplies, laboratory tests, and the hospital room were identified from the patient's bill. Personnel costs were obtained from a log maintained by the home antibiotic team members. Charges accrued were converted to costs using the cost-to-charge ratio for each cost center. Fiscal analysis was performed using a subgroup of six patients with osteomyelitis. For all the patients, the mean duration of home therapy was 26 days. Inpatient treatment averaged 15.9 days. No major catheter-related problems were identified. For the osteomyelitis patients, the total cost of therapy, both inpatient and outpatient, was $57,854. If all of the therapy for this subgroup of patients had been provided on an inpatient basis, the total cost would have been $98,314. The home intravenous antibiotic program was determined to be feasible and cost-effective.

Adult↗
PubMed1984

Warfarin resistance with nafcillin therapy.

Drug-induced warfarin resistance may be mediated by the direct effect of a drug on warfarin's absorption, excretion, distribution, or metabolism. A 29-year-old man on long-term stable anticoagulation therapy with warfarin sodium developed resistance to warfarin while receiving nafcillin. His prothrombin time ranged between 14 and 17 s (control, 12 s) despite an increase in his warfarin dosage to 25 mg/d. Pharmacokinetic studies showed that the decreased hypoprothrombinemic effect of warfarin was most likely due to rapid metabolism of the anticoagulant induced by nafcillin. Warfarin's half-life was 11 hours when the patient was on nafcillin therapy and 44 hours when he was off nafcillin therapy. This interaction may be clinically important in patients requiring concomitant administration of nafcillin and warfarin.

Adult↗
PubMed1983

Prediction of maintenance warfarin dosage from initial patient response.

This study was conducted to determine the reliability of two methods of predicting maintenance warfarin dosage. Fifty-nine patients were studied using Method 1 and 44 using Method 2. Both methods produced a statistically significant correlation between predicted and actual dose for the two populations. However, actual vs. predicted doses for individual patients were significantly different. Method 1 predicted a dose within +/- 2.5 mg/d of actual dose in only 40.7 percent of patients. With Method 2, the corresponding value was 56.8 percent. Although the linear regression was statistically significant in our population, many patients would have excessive or subtherapeutic dosage predictions.

Adult↗
PubMed1981

Acquired warfarin resistance and weight-reducing diet.

A frequent cause of acquired warfarin resistance is drug interaction; however, ingestion of large amounts of vitamin K in food may also be an etiologic factor. A 31-year-old woman on a weight-reducing diet showed evidence of resistance to warfarin sodium therapy. On a regimen of 35 mg of oral warfarin sodium daily, prothrombin time was 14 s (control, 12 s). Pharmacokinetic studies did not reveal any evidence of impaired adsorption or increased catabolism of the drug. The half-life of her oral warfarin was 26 hours (normal, 15 to 56 hours). Although end-organ resistance was not studied fully, a change of her vegetable-rich, weight-reducing diet (vitamin K content, 1,277 microgram) to a regular diet (vitamin K content, 360 microgram) resulted in substantial reduction in her warfarin resistance. We conclude that in patients on vegetable-rich, weight-reducing diets, a relative resistance to warfarin may be secondary to their increased dietary intake of vitamin K.

Adult↗
PubMed1979

Pharmacist management of anticoagulant therapy in ambulant patients.

The development, operation, patient management protocol and teaching activities of a pharmacist-managed anticoagulant clinic for ambulatory patients are described. Pharmaceutical services provided in the ambulatory clinic include (1) contribution to the problem-oriented medical record; (2) patient education; (3) therapeutic response monitoring; (4) drug information; (5) drug distribution; and (6) inservice education. A pharmacist completes a medication history on initial visit; assesses and adjusts anticoagulant therapy based on physical examination, detection of adverse drug reactions and laboratory test results; schedules return clinic visits; provides patient education; and records, in the patient's medical record, the assessment and results of treatment. Treatment adjustments made by the pharmacist are based on an oral anticoagulant protocol and reviewed by the clinic cardiologist. The clinic serves as a teaching site for undergraduate pharmacy students, Doctor of Pharmacy students and hospital pharmacy residents. The anticoagulant clinic gives the pharmacist a unique opportunity to provide comprehensive pharmaceutical services, to establish effective, long-term professional relationships with ambulant patients and their families, and to foster interdisciplinary health team activities.

Anticoagulants↗
PubMed1975

Pharmacist's role in management of hypertensive patients in an ambulatory care clinic.

A program involving a pharmacist in the management of ambulatory hypertensive patients is discussed. A hypertension monitoring protocol was developed by a physician and a pharmacist. The protocol provided for initial patient assessment and treatment by the physician, counseling and education of the patient by the pharmacist, patient follow-up by the pharmacist every one to two months and follow-up by the physician every four to six months. In the first four months of the program, 28 of 75 newly diagnosed hypertensive patients were referred by the physician to the pharmacist for follow-up.

Ambulatory Care↗