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Results for “Prescriptions--changes”

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PubMed2003

Head lice diagnosed in general practice in the West Midlands between 1993 and 2000: a survey using the General Practice Research Database.

The potential of the General Practice Research Database (GPRD) for communicable disease surveillance was explored using head lice as an example. All diagnoses of head lice and prescriptions for parasiticidal agents from 1993 to 2000 in the West Midlands were analysed. Diagnoses reached a peak of 28.2 per 1,000 patient years at risk and total prescriptions reached a peak of 27.1 per 1,000 patient years at risk in 1997. Malathion and permethrin were prescribed most often. The proportion of further parasiticidal prescriptions issued within 30 days of the initial prescription increased to a peak of 11.5% of prescriptions in 1997. The ratio of the same:different further prescriptions changed during the study period, reaching a high of 5:1 in 2000. These trends are mirrored by the Royal College of General Practitioners (RCGP) Weekly Returns Service and Prescribing Analysis and Cost (PACT) data. Use of GPRD provides additional insights into patient data, particularly on prescribing, that would not be available from other sources.

Adolescent↗

PubMed2005

A ward-based procedure for assessment of fluid status in peritoneal dialysis patients using bioimpedance spectroscopy.

OBJECTIVE: This study was carried out to evaluate a procedure for converting bioimpedance spectroscopy (BIS) data to a clinically useful measure of fluid status that is easily interpreted by nursing staff and patients. DESIGN: The ratio of extracellular water (ECW) to total body water (TBW) in a cohort of peritoneal dialysis (PD) patients was compared with the distribution for normal control subjects. The result was expressed as the difference between the measured ECW/TBW ratio and the mean ratio for age- and sex-matched controls divided by the standard deviation for the controls (the "hydration score"). Where possible, interventions were made to reduce the target weight in patients with a hydration score greater than +2.0. SETTING: This clinical study was carried out in the nurse-led outpatient PD unit at St. James's University Hospital. BIS measurements were carried out during routine clinic visits. The data for the control subjects were obtained in a range of settings in the UK and the Czech Republic. PATIENTS: 31 PD patients (21 M, 10 F; aged 19 - 78 years) who came to the PD unit for routine procedures during the study participated. RESULTS: The mean hydration score for PD patients was significantly higher than for the control subjects (+1.3 vs 0.0, p < 0.0001). 11 (35%) patients had a hydration score greater than +2.0, compared with only 2.5% of the controls; systolic blood pressure was greater than 130 mmHg in only two of these patients. After a 3-month follow-up, a weight reduction of 3.6 +/- 2.3 kg had been achieved in 7 patients through modality change and implementation of prescription changes, with no adverse effects. CONCLUSIONS: Although this was a small study, all the data collected indicated that the hydration score provides a reliable indication of fluid status in PD patients. BIS measurements are now carried out at 6-month intervals and are used to monitor the effect of interventions.

Adult↗

PubMed2005

[A contribution of a pharmaceutical department to the safety management of an outpatient's cancer chemotherapy].

A concern about safety management is growing rapidly in the field of an outpatient's cancer chemotherapy. Therefore, the pharmaceutical department of Tokai University Hachioji Hospital has employed; (1) a system to check injection prescriptions accompanied by records of drug administration and (2) an injection drug preparation worksheet for a certain communication. The results that examined their usability were as follows: (1) a prescription check found a deviation of recipes from the protocol, then all of the deviations were revised, (2) use of the worksheet with an indicated cancellation line completely prevented preparation mistakes in the case of a prescription change. Consequently, the safety management of an outpatient's cancer chemotherapy has made progress due to an application of the system and worksheet by the pharmaceutical department.

Ambulatory Care↗

PubMed1991

Evaluation of CAPD prescription.

Adequacy of CAPD has not been established. The recommendation is a Kt/V (K, total urea clearance in ml/min; t. time in minutes on dialysis; and V, total body water which is the volume of distribution of urea) greater than 1.5/week and/or a creatinine clearance (residual + dialysis) greater than 40 l/week/1.73 m2. We followed 20 CAPD patients for 38.6 +/- 28 mo. We measured blood urea nitrogen, serum creatinine, body weight, residual renal function (Kr), normalized protein catabolic rate (NPCR), Kt/V/week and creatinine clearance (CC) l/w/1.73 m2. We obtained the following values: B Wt 72 +/- 16 kg, BUN 56 +/- 13 mg/dl, s. Cr. 12.6 +/- 5 mg/dl, Kr 0.6 +/- 1 ml/min, NPCR 0.84 +/- 0.3 g/kg/day, Kt/V/week 1.8 +/- 0.3 and CC 50.4 +/- 10 l/w/1.73 m2. Patients dialyzed with a wide range of prescription. There was a good correlation between Kt/V and CC. There was no correlation between the dialysis prescription changes in weight and biochemical determinations. There was a direct correlation between Kt/V and NPCR: patients who were dialyzed more eat more. Of the 20 patients, 10 had 24 hospitalizations, and of these were 12 due to peritonitis. Dialysis prescription and biochemical findings of these patients did not differ significantly from nonhospitalized patients. Larger prospective studies are necessary to determine the adequate range of CAPD prescription and its relationship to morbidity and mortality.

Adult↗

PubMedDate not supplied

Recombinant human erythropoietin correction of anemia. Dialysis efficiency, waste retention, and chronic dose variables.

A clinical review of patients who were treated with recombinant human erythropoietin was undertaken to evaluate the effect of partial correction of anemia upon dialysis function and waste retention. Assessment of possible variables that might influence the dosage response was also undertaken, both in a retrospective and prospective manner. Finally, a chart review of patients' symptoms while on dialysis was done to evaluate the effect of correction of anemia. Hematologic improvement was noted in all patients placed on hormone therapy with the correction of hemoglobin and hematocrit. There was no effect on white cell count, although a slight change in the differential was noted at target and one year; platelets rose to a new steady state. Dialysis efficiency was decreased slightly for urea and markedly for creatinine, probable reflecting the distribution characteristics of the latter. Retention of urate, phosphorus, and potassium was noted at target, with a drop toward usual serum levels with minimal dialysis prescription change. Variables such as age, gender, race, and dialysis prescription were compared in an effort to establish dosage variation, but no statistically significant changes were seen. There was an inverse trend in dosage, however, with increasing dialysis efficiency. Patients also seemed to be more tolerant of their dialysis treatments when nonanemic, compared to when anemic. While there is retention of some substances with improvement of anemia, the levels were easily corrected with adjustment of the dialysis prescription. No definite relationship could be seen in any of the variables studied and hormone dose requirements. Attention must be paid to adequate dialysis prescription in the erythropoietin treated patient.

Anemia↗

PubMed1995

[Does the consumption of drugs change among nursing home residents after an intervention by systematic visits of "family physicians"?].

The aim of the study was to investigate whether an intervention by the patient's general practitioner (GP) changes the consumption of medicine in nursing homes. It was designed as an intervention study including 111 inhabitants in nursing homes in a municipality (Odder). All the general practitioners in this local authority visited and evaluated their own patients. It was found that there were great variations in the consumption of medicine between nursing homes. Sixty-six percent of the inhabitants had their prescriptions changed after the intervention. Thirty-six percent had their prescriptions stopped and 30% received a new prescription. It is concluded that a single visit with a special focus on medicine consumption by the GP caused a large number of changes in the residents' consumption of medicine in nursing homes.

Aged↗

PubMed1998

Original research: the relationship between dialysis adequacy and quality of life: a report of a pilot study.

Adequacy of dialysis, as measured by urea kinetic modelling (UKM), is considered an extremely important clinical outcome for all dialysis programs. While improving adequacy has been clearly linked to decreased mortality among hemodialysis patients, the relationship between adequacy and patients' quality of life remains less clear. Patients with higher Kt/Vs live longer, but do they live better? This paper describes the results of a pilot study designed to examine the relationship between adequacy of hemodialysis and the patient's perceived quality of life. This time series study employed a convenience sampling technique consisting of all willing new patients to join an in-centre hemodialysis program in a six-month period. The adequacy of each new patient's dialysis prescription was determined by analyzing urea kinetics at one and three months following the commencement of therapy. Dialysis prescription changes were made by the interdisciplinary team, as necessary and where possible, to achieve a minimum Kt/V of 1.2. Each new patient's quality of life was measured at the same time intervals, that is, one and three months using two instruments. The first, the SF36 is a generic 36-item instrument designed to measure a range of functioning and well-being. The second, the Kidney Disease Questionnaire (KDQ) is a disease-specific quality of life instrument designed for use with chronic hemodialysis patients. Results showed that both adequacy and quality of life scores improved from one to three months. There are, however, too many competing explanations to assume a relationship between the two variables. Future analysis with a larger sample will employ an analysis of covariance to look for relationships.

Adult↗

PubMedDate not supplied

Plasma iohexol clearance in automated peritoneal dialysis--its role in adequacy determination.

OBJECTIVE: To compare the relationship of plasma iohexol clearance to standard adequacy measures in an automated peritoneal dialysis (APD) population. DESIGN: Prospective, nonrandomized, open label, simultaneous clearance studies of novel (iohexol) and traditional (urea and creatinine) markers of dialysis quantitation. SETTING: Outpatient peritoneal dialysis units associated with tertiary care university hospitals. PATIENTS: Eighteen stable patients, 13 undergoing continuous cycling peritoneal dialysis (CCPD) and 5 receiving intermittent dialysis, who underwent 24-hour clearance studies were enrolled in and completed the study. INTERVENTIONS: Each subject received 15 mL of iohexol intravenously the morning of a scheduled dialysis night. Blood was obtained for determination of serum concentrations of urea nitrogen and creatinine, and plasma iohexol concentration. Dialysate and urine were collected over 24 hours. MAIN OUTCOME MEASURES: Urea and creatinine data from the total pooled dialysate and from the 24-hour urine collection were used to calculate daily Kt/Vurea and normalized total daily creatinine clearance (CrCl). Total plasma iohexol clearance was calculated using a one-compartment model with the Brochner-Mortensen correction. RESULTS: Normalized [to 1.73 m2 body surface area (BSA)] iohexol clearance correlated very well with normalized CrCl (r2 = 0.777; p < 0.001). A weaker correlation was observed between Kt/Vurea and normalized iohexol clearance (r2 = 0.213; 0.05 < p < 0.1). When data are not normalized using BSA or urea distribution volume, the regressions are improved for both creatinine (r2 = 0.820) and urea (r2 = 0.533). These results were comparable between those on CCPD and those on intermittent therapy. CONCLUSION: Total plasma iohexol clearance provides a simple assessment for APD adequacy by eliminating collection problems inherent to the methodologies currently employed. Such simplicity allows for more frequent assessments of delivered dialysis dose and efficacy of prescription changes.

Blood Urea Nitrogen↗

PubMed1998

Effect of the British warning on contraceptive use in the General Medical Service in Ireland.

In October 1995 the UK Committee of Safety of Medicine (CSM) issued a warning about the safety (thromboembolic disease) of the third generation oral contraceptive steroids (OCS) recommending a switch to older agents except where women were intolerant of first and second generation OCS. Advice by the Irish regulatory authority (Irish Medicines Board) did not recommend such a switch. This pill scare lead to some UK users stopping OCS mid-cycle and a rise subsequently in abortions and pregnancies was noted. To determine whether local or UK advice was followed we obtained data from the General Medical Service (GMS) Scheme on the use of contraceptive steroids prescribed before and after the CSM's warning. The results show a clear shift from usage of the third generation OCS to the second generation OCS and norgestimate-containing OCS. We have also noted a marked fall in the overall use of the combined OCS, a trend that was noted in the U.K. It is clear that prescribers and pill users were influenced more by advice from the UK than by Irish regulatory authority. There is now a centralised European mechanism to licence drugs in the European Union (EU). We need to develop an EU perspective to issues of drug safety, as constituent nations are no longer isolated islands.

Adolescent↗

PubMed1996

Don't be scared.

Explore the source record for details and available documents.

Behavior↗