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At least 181 records · Page 10Linked to original sources
PubMed1996

Remifentanil.

Remifentanil is a new selective mu opioid receptor agonist of higher potency than alfentanil, with pharmacological effects that essentially parallel those of alfentanil and other opioids in this class. Unlike other opioids, remifentanil is rapidly hydrolysed by nonspecific plasma and tissue esterases: this imparts brevity of action, precise and rapidly titratable effects (due to rapid onset and offset), non-cumulative opioid effects and rapid recovery after cessation of administration. The onset of action of remifentanil is similar to that of alfentanil, although its offset is considerably more rapid and independent of the duration of infusion. Remifentanil also has a sparing effect on hypnotics and sedatives. Its brevity of action ensures not only a rapid resolution of adverse effects but also a rapid offset of analgesic effect. Therefore, appropriate postoperative analgesia, when necessary, should be established before discontinuation of remifentanil infusion. The unique pharmacokinetic profile of remifentanil facilitates 'real time' management of intraoperative stress, as well as provision of optimal intraoperative analgesia without compromising recovery for a variety of surgical procedures.

Alfentanil↗
PubMedDate not supplied

Physicians' database searches as a tool for early detection of epidemics.

We analyzed retrospectively the use of Physician Desk Reference Database searches to identify epidemics of tularemia, nephropathy, Pogosta disease, and Lyme disease and compared the searches with mandatory laboratory reports to the National Infectious Diseases Register in Finland during 1995. Continuous recording of such searches may be a tool for early detection of epidemics.

Alphavirus Infections↗
PubMedDate not supplied

[Infections in non-transplanted oncohaematological patients].

Oncohaematological patients present a high incidence of infections, which are one of the principle causes of morbidity and mortality. There are different types of immunodepression related to the disease, the moment of its evolution and the treatment received. For practical purposes we will distinguish between patients with severe neutropenia, those with some alteration to humoral immunity and, finally, cellular immunodeficiencies. There are no immunodeficiencies associated to each disease, instead several immunitarian deficiencies can be associated in a single clinical entity. Neutropenic patients, generally with acute leukaemias and following intensive chemotherapy, have bacterial and fungal infections conditioned by the intensity and duration of the neutropenia. In the case of patients with humoral immunodeficiency (multiple myeloma, chronic lymphatic leukaemia, splenectomised) there are frequent infections by encapsulated germs. When there is cellular immunodepression (Hodgkin's disease, advanced chronic lymphoproliferative syndromes, treatment with glucocorticoids, analogues of the purines and treatment with monoclonal antibodies) the risk of infection by opportunist germs is conditioned by the reduction of the figure of CD4 lymphocytes. We review the different strategies of prophylaxis and treatment in each of the situations.

Clinical Trials as Topic↗
PubMed1993

Evaluation of an aseptic technique testing and challenge kit (ATTACK).

Currently, there is considerable discussion and concern about quality assurance when sterile pharmaceuticals are prepared by pharmacists and other health professionals. This study describes the utility of a kit made by Marsam Pharmaceutics Inc. in detecting microbial contamination during simulated drug transfers by syringe. Common microbial detection techniques were incorporated in a simple series of transfers intended to simulate actual use. Growth promotion studies were carried out using Trypticase Soy Broth initially in tubes and then in vials (as supplied in the kit). Three test organisms were employed (Staphylococcus epidermidis, Bacillus subtilis, and Candida albicans) and inoculated at three levels, < 1000, < 100, and < 10 CFU/mL. All studies demonstrated growth occurring in 100% of the trials in 8 days. Similar studies were initiated in stored media (32 month) to determine the effects of time on the ability of the medium to support growth. Growth promoting ability of 32 month old media showed no significant difference. 100% of the vials inoculated showed growth in 8 days. Once the growth promoting qualities of the medium and vials was established a kit was developed then a study to determine the effectiveness of the kit as used was undertaken. Kits were manipulated according to the directions for use by a trained individual, under aseptic conditions and by an untrained individual in an area described as less than desirable. No growth occurred in the vials of the 10 kits used to illustrate good technique and good environmental conditions with 30% (3 of 10) of the kits showing contamination when transfers by syringe were carried out in the less than desirable setting.(ABSTRACT TRUNCATED AT 250 WORDS)

Asepsis↗
PubMed1993

Pharmacoeconomic series: Part 3. Applying pharmacoeconomic and quality-of-life measures to the formulary management process.

P & T Committees were established as an institution's primary organizational tool for the development and maintenance of the formulary. Traditionally, P & T Committees have focused on the safety, efficacy, and acquisition cost of medications to be considered for formulary approval. Today, the impact of pharmaceuticals on patients' quality-of-life and total health care expenditures are increasingly important considerations to be weighed by P & T Committees. Pharmacoeconomic analyses and quality-of-life outcomes represent valuable contributions to the formulary decision-making and management process.

Anti-Bacterial Agents↗
PubMed1993

Patient-focused care: key principles to restructuring.

Patient-focused care (PFC) is a unique patient care delivery model that is becoming more popular in today's hospitals. Bishop Clarkson Memorial Hospital in Omaha, Nebraska, was one of the first hospitals to implement PFC. Clarkson used four principles to guide its pilot unit implementation--grouping similar patient populations, moving services closer to the patient, broadening staff skills, and simplifying processes. The four principles and their implementation are described; preliminary results are reported.

Attitude of Health Personnel↗