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Biomedical subjects

T S Lesar

Publications and source records attributed to T S Lesar.

10 recordsLinked to original sources
PubMed1991

Preventing medication prescribing errors.

Medication errors may arise in the manufacture, preparation, distribution, and administration of drugs. Physician prescribing errors are of particular importance as such errors have been associated with significant adverse patient outcomes. The pharmacist plays an important role in preventing such errors from reaching the patient. The purpose of this article is to define and illustrate the various error types and the mental attitudes that cause individuals to prescribe errant orders. Through better understanding of the cause of prescribing errors, pharmacists may be able to improve the error prevention services they provide. Based on the error types discussed and their causes, recommendations are proposed to decrease the frequency of such errors and thereby improve the quality of patient care.

Drug Prescriptions↗
PubMed1990

Medication prescribing errors in a teaching hospital.

A study of prescribing errors committed by physicians that occurred in a tertiary-care teaching hospital is reported. From a total of 289 411 medication orders written during the 1-year study period, 905 prescribing errors were detected and averted, of which 522 (57.7%) were rated as having potential for adverse consequences. The overall detected error rate was 3.13 errors for each 1000 orders written and a rate of 1.81 significant errors per 1000 orders. The error rate (4.01 per 1000 orders) was greatest between 12 pm and 3:59 pm. First-year postgraduate residents were found to have a higher error rate (4.25 per 1000 orders) than other prescriber classes, and obstetrics/gynecology services (3.54 per 1000 orders) and surgery/anesthesia services (3.42 per 1000 orders) had greater error rates than other services. The study results demonstrate the significant risk to patients from medication prescribing errors. Educational, operational, and risk-management activities should include efforts directed at reducing the risk to patients from prescribing errors.

Hospital Bed Capacity, 500 and over↗
PubMed1990

Lindane (Kwell)-induced aplastic anemia.

Numerous toxic exposures have been implicated in causing aplastic anemia. Thirteen cases of aplastic anemia and 5 cases of other blood dyscrasias, eg, red blood cell aplasia and thrombocytopenia, associated with lindane, have been reported in the literature. However, aplastic anemia secondary to the scabicidal product (lindane [Kwell]) has not been documented, to our knowledge. We present the case of a 21-year-old man with a diagnosis of aplastic anemia, known prolonged exposure to lindane, and documented elevated serum lindane levels. His clinical course is described as well as various defects are explored for the aplasia.

Administration, Topical↗
PubMed1989

Plasma fluorescein and fluorescein glucuronide in patients with selected eye diseases.

Systemically administered fluorescein (F) is rapidly transformed to the fluorescent metabolite fluorescein glucuronide (FG). Little is known about how diseases can influence the synthesis or disposition of FG. We studied F and FG in the plasma ultrafiltrate of 75 people who were normal or had diabetes, retinitis pigmentosa, or idiopathic rhegmatogenous retinal detachment. F and FG were determined by high-performance liquid chromatography. The concentration of FG was comparable to F 1 h after an intravenous injection of F, both in normal subjects and in patients with retinitis pigmentosa, which suggests that FG may not be an important contributor to the vitreous fluorescence at that time. At later times FG substantially exceeded F. The concentration of FG was significantly higher in diabetics than in the other groups 14 h after an oral dose of F. Accordingly, the possible effect of disease on plasma dye concentrations should be considered in studies measuring F by fluorescence hours after systemic F administration, since this could influence the intraocular fluorescence irrespective of any alteration in ocular function.

Adult↗
PubMed1989

Streamlining antimicrobial therapy through pharmacists' review of order sheets.

The impact of a pharmacy-conducted intervention program designed to contain costs by "streamlining" antimicrobial therapy is described. Streamlining of antimicrobial therapy may involve simplifying routes of administration, decreasing the dose or frequency of antimicrobial administration, or converting from multiple-agent therapy to single-agent therapy. Beginning on December 1, 1987, pharmacists at this university-affiliated teaching hospital used the antimicrobial order sheet (AOS) filled out by all prescribers of anti-infective agents to identify orders that were potential candidates for streamlining. Interventions involved a discussion between the pharmacist and prescriber in which the pharmacist specified the reasoning behind the recommended change. For each recommendation that was accepted by the prescriber, the cost savings per day was determined by subtracting the daily cost of the recommended streamlined therapy from the daily cost of the original "problem" therapy. Data collection continued until May 1, 1988. During that five-month period, 162 out of 173 pharmacist-initiated streamlining recommendations were accepted by prescribers, resulting in a total cost savings of $19,864. The average cost savings per intervention was $122.62. The most frequent intervention involved decreasing the frequency of i.v. administration, decreasing the dose, or both. The intervention that resulted in the greatest average cost savings involved simplifying the route of administration or discontinuing antimicrobial therapy entirely. The projected annual cost savings of this program is $47,700. By using information from AOSs to identify problem antimicrobial orders, pharmacists were able to recommend streamlining of antimicrobial therapies that resulted in an average cost savings of about $122 per intervention.

Anti-Infective Agents↗
PubMed1987

Comparison of ophthalmic beta-blocking agents.

Glaucoma is described, and the chemistry, pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosage and administration of betaxolol and levobunolol in comparison with timolol are reviewed. Betaxolol and levobunolol are two beta-adrenergic blocking agents being marketed as ophthalmic solutions for treatment of primary open-angle glaucoma (POAG) and ocular hypertension (OHT). Betaxolol is a relatively cardioselective beta-adrenergic blocker, while levobunolol is a nonselective beta-adrenergic blocking agent. Double-blind comparative trials have suggested that betaxolol has an equal to slightly lower efficacy and levobunolol has equal efficacy in reducing intraocular pressure (IOP) compared with timolol, the first ophthalmic beta blocker. A mean reduction in intraocular pressure of 15-35% occurs with both betaxolol and levobunolol and is reported to be maintained with prolonged use. Betaxolol is associated with a higher (25%) incidence of local ocular adverse reactions than timolol. However, betaxolol produces less systemic beta 2- and possibly beta 1-adrenergic receptor blockade than either timolol or levobunolol. Betaxolol may be relatively safer to use in patients with reactive airway disease than either timolol or levobunolol. Levobunolol causes a similar to greater incidence of local ocular adverse reactions and similar systemic beta blockade compared with timolol. Levobunolol may possibly be longer acting than timolol, allowing more patients to be controlled by once-daily dosing. Betaxolol and levobunolol appear to be similar to timolol in controlling IOP in patients with POAG and OHT; additional experience with these agents is needed to assess the advantages and disadvantages of each agent.

Adrenergic beta-Antagonists↗