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PubMed1985

Evaluation of 516 cardiopulmonary resuscitation attempts.

All adult cardiopulmonary resuscitations attended by the pharmacy department at a 486-bed tertiary-care institution were analyzed over a 24-month period. Data describing patient demographics, drug and equipment use, and patient survival were collected on 516 consecutive adult arrests. These data were recorded on a report form by a pharmacy technician and were classified as cardiac, respiratory, trauma, or other. Trauma included arrests caused by motor-vehicle accidents and gunshot wounds, and other included arrests caused by anaphylaxis or seizures. The majority of arrests (70%) were classified as cardiac, 24% as respiratory, and 6% as other. Overall, 54.5% of the patients suffering from arrests were resuscitated successfully. There was an equal distribution of arrests throughout the day. The mean duration of the resuscitation efforts was 38 minutes with a trend toward greater patient survival when resuscitation efforts lasted less than 15 minutes. Arterial blood-gas determinations were made in 81% of the arrests, defibrillations in 40%, and pacemaker or chest tube insertion in less than 10%. Sodium bicarbonate was the most frequently administered medication, followed by calcium salts and atropine sulfate. Lidocaine was used in 83% of the cases requiring antiarrhythmic therapy. Pressor support was required in 44.6% of the cases; norepinephrine bitartrate was the first-line pressor agent. Drugs not categorized as essential according to the American Heart Association's Advanced Cardiac Life Support (ACLS) standards were administered infrequently. Hospitals may benefit from arrest data in assessing their equipment and supply needs, staffing patterns, and personnel training programs.

Evaluation Studies as Topic↗

PubMed2000

Nonprescription medicine use in a multiple sclerosis clinic population.

AIMS: To determine the use of nonprescription medicines in a cohort of multiple sclerosis (MS) patients and to identify a subgroup of patients liable to spend more on nonprescription medicines METHODS: A questionnaire was given to MS patients attending a neurology out-patients clinic during the previous year. Medicines from a General Practitioner (GP), pharmacy and 'other' sources utilized in the last month were determined, along with demographic data. Additional information was obtained from hospital notes. RESULTS: One hundred and seventeen MS patients responded to the questionnaire, giving a response rate of 79% (117/148). Responders differed from nonresponders only in age, with responders being significantly older than nonresponders (P = 0.011). Over one-third of medicines taken in the last month were nonprescription medicines (35%; 219/627). A gamolenic acid containing preparation was the most popular, purchased by 28% of patients. Fifteen percent (17/117) of MS patients had exceeded the recommended daily allowance of a vitamin (frequently vitamins A, D and E), and one exceeded the upper safe level for daily self-supplementation of vitamin A and D. Females spent significantly more than males in the previous month ( pound10. 09 compared with pound5.53, respectively; P = 0.022). Patients who were older, reported worsening MS symptoms in the last year and those who exhibited greater disability were more likely to have been prescribed medicines by a GP (P < 0.0005), although they were not more likely to self-prescribe or take alternative remedies (P > 0. 05). However, those with poorer mobility were significantly less likely to have purchased a pharmacy medicine in the last month (P = 0.033). CONCLUSIONS: MS patients were high users of nonprescription medicines. A typical subgroup of MS patients that spent more on nonprescription medicines could not be identified, aside from females. Furthermore, the strong predictors for increased use of prescription medicines (increasing age, severity of symptoms in the last year and poorer mobility) were not found for nonprescription medicines. Excessive intake of the fat soluble vitamins could lead to hypervitaminosis, the effects of which could exacerbate or mimic MS symptoms. Health professionals should be aware of these issues and counsel the MS patient accordingly, particularly as the majority purchased products from 'other' sources where typically there is no health-professional available to give advice. The limited use of pharmacy medicines by the more disabled patient could indicate a problem with access to the pharmacy, or could reflect the greater use of prescription medicines.

Cohort Studies↗

PubMed1991

[The distribution effects of the Danish 800 crown rule. Preliminary results of the DIKE study. Choice of drugs and drugs used by the population].

During the period 1 July 1989 to 31 December 1990, patients had to pay the full price for subsidized medicine up to DDK 800 (66 pounds) per calendar year. The consequences for the population were examined by a representative national survey (January 1990) and for the patients by interviews at pharmacies (December 1989 and April 1990). Fourteen percent of the population had exceeded the limit of DDK 400 (33 pounds) for the second half of 1989. By the end of December 1989, 53% of patients at pharmacies had exceeded the limit. According to the national health survey (1986) 51% of the population took medicine during a period of two weeks; 58% female, 42% male. In 1990, 41% of the population had no medicine expenses. Among the other fraction 15% had expenses of DDK 200 (16 pounds) or more, monthly. Among patients at pharmacies 22-25% had expenses to that amount. More than 90% of the patients at pharmacies bought the prescribed medicine or the medicine normally used. Less than 10% asked the physician to prescribe a cheaper medicine. The new regulation on medicine reimbursement has not yet induced greater price-consciousness in the users. Whether this is possible by economic means, is an open question.

Adult↗

PubMed1982

Pharmacists' perceptions of their patient counseling activities.

The counseling of patients regarding their drug therapy has been advocated as an important part of pharmacy practice. Both the need and potential for this counseling have been demonstrated. Yet, studies generally have been critical to the extent and quality of the counseling provided. This report describes counseling as it is perceived by community pharmacists who perform this activity. A mail survey, developed from interviews with pharmacists, was distributed to a random sample of Ohio community pharmacists. A net response of 76.8 percent (506 usable questionnaires) was achieved. Respondents have strong positive beliefs about counseling. When the service is provided by pharmacists, counseling sessions are usually brief, pharmacist-initiated, and one-way conversations to the patient. Although there is considerable variation as to the classes of drugs for which counseling is provided and the types of people who receive it, the components of counseling appear to be constant. Attempts to change or expand counseling activities may be compromised unless there is a common understanding among all parties involved of what counseling is. This report is one step toward achieving that understanding. It may be used by community pharmacists to measure and compare their counseling behaviors and beliefs with those of their peers and as a means of identifying possible areas for change in their own practices.

Attitude of Health Personnel↗

PubMed1997

Perceived level and sources of stress in university professional schools.

The purpose of this study was to investigate the perception of level and sources of stress in students of two baccalaureate nursing programs, to compare these groups in their perceived stress and to compare the nursing groups to those enrolled in other health-related disciplines: Medicine, Pharmacy and Social Work. The study was descriptive correlational in design. The sample consisted of 552 full-time university students enrolled in years 2, 3 and 4 of their programs in selected disciplines. Data were collected by means of a questionnaire consisting of three main instruments: the Beck-Srivastava Stress Inventory (BSSI), the General Health Questionnaire 30-item version (GHQ-30) and a demographic profile. Data were analyzed using the SPSSx Statistical Package and included analysis of variance, frequency distribution, measures of correlation, item analysis and factor analysis. The results revealed that baccalaureate nursing students, regardless of year in program or university of attendance, experienced higher levels of stress and higher levels of physiological and psychological symptoms than students in other health-related disciplines. Identified stressors among the disciplines are also reported in the article.

Adult↗

PubMed1991

A study pre and post unit dose conversion in a pediatric hospital.

Two pediatric medical wards were studied pre and post unit dose conversion using some of the methods described by Schnell et al. The proportion of nurses' time spent on medication related activities decreased from 23.7% pre to 21.6% post unit dose conversion. Nurses' attitudes to the roles of pharmacists and nurses did not change overall and there were significant improvements in their perceptions of the drug distribution system. Observed medication incident rates decreased from 10.3% to 2.9% when wrong time errors were excluded. Medication room audits showed less opportunity for error post-conversion. Work sampling of pharmacists' activities showed no significant change in the amount of time spent on distribution activities. Medication costs decreased by 4% under unit dose drug distribution.

Attitude of Health Personnel↗

PubMed2002

Preventing exacerbation of an ADE with automated decision support.

This case demonstrates that, despite physician disregard of appropriate expert system warnings during computerized physician order entry, the distribution of alert "override" warnings to non-physician members of the clinical team can help avert adverse drug events.

Adult↗

PubMed1985

Pharmaceutical services in hospitals treating pediatric patients.

A survey was conducted of pharmaceutical services in 120 of the 325 short-term hospitals associated with accredited pediatric residency training programs, 52 pediatric hospitals, and 68 adult hospitals with pediatric units or floors. The mail survey conducted in 1983 had a 70% response. Centralized pharmaceutical services were offered by the majority of the hospitals. Seventy-two percent of the respondents indicated that either a complete or partial unit dose drug-distribution system was used for most of their pediatric patients, while 25% indicated that they used either the traditional individual patient-fill system or some combination of drug-distribution systems. A total of 80% of the hospitals provided either complete or partial i.v. admixture services. The preparation of total parenteral nutrient solutions was the most common admixture service provided. Clinical services were provided, to some extent, by 63% of the respondents. Computers were used for multiple functions, such as generating patient profiles, organizing the formulary, and providing labels for unit dose and i.v. admixture services, by 33% of the respondents. Selection of therapeutic alternates was performed by pharmacists in 51% of the responding hospitals, and the majority of institutions had formulary systems. Modern drug-distribution systems and clinical services have been established in many hospitals treating pediatric patients.

Computers↗

PubMed2006

Survey of medical ethnobotanicals for dental and oral medicine conditions and pathologies.

Ethnomedical questionnaires were distributed in Chicago, Costa Rica, and Colombia to identify the most common over-the-counter (OTC) plant or plant-based products advocated for treating oral pain, ulcerative conditions, and cancer within these locations. Over 100 plants or plant-based herbal preparations and commercial products, purchased from local botanical markets and pharmacies, were advocated for the treatment of oral medicine conditions. Locally familiar and common language names were attributed to the plant products at the time of purchase. Plant products or plant-based commercial products containing plant-based essential oils, anesthetic constituents, and or chemical compounds recommended as OTC oral medicine preparations were systematized, tabulated, and correlated with the published phytotherapeutic literature. Though pharmacognostic research is available for some of the species collected, further ethnographic research is needed to correlate common names with the accurate taxonomic identification for each plant species. Furthermore, epidemiological research is needed to verify the use and standardized dosage for OTC ethnomedicine preparations for oral medicine conditions. Pharmacognostic research and clinical trails which can verify taxonomy, dose, safety, active principles, and efficacy of these OTC oral medicine products must be enhanced in order to verify the claimed validity in contemporary, global, oral medicine practice.

Data Collection↗

PubMed1985

A poison prevention program for new mothers.

A program was developed to teach new parents about poison prevention and to introduce syrup of ipecac into their homes. Although the incidence of accidental poisonings is low in newborns, the objective of the program was to educate the parents before the child reaches the age when poison accidents are more likely to occur. To accomplish this a special packet was created which contained poison prevention literature and a redeemable coupon for a free one ounce bottle of syrup of ipecac. The packets were distributed to the new mothers during the postpartum hospital stay by the obstetrical nursing staff. Over 10,000 new mothers received the packets during a 10-month period. This program was funded by a grant from the Hennepin County Community Health Department and the syrup of ipecac was donated by a local retail pharmacy chain.

Female↗

PubMedDate not supplied

Drugs of Dependence Monitoring System: an effective check of the movements of certain drugs in Australia.

For the past 13 years the Commonwealth Department of Health has operated a computerized monitoring system which records the movements throughout Australia of selected legal drugs with abuse potential. The Drugs of Dependence Monitoring System is designed to prevent diversion to the illicit market. From the moment of import or manufacture, every movement of the selected drug is monitored until the drug reaches the final distributor, in most cases a pharmacy, a veterinarian or a hospital. Approximately 300,000 movements are checked each year. All drugs used in Australia, which are covered by the Single Convention on Narcotic Drugs, 1961, and the 1971 Convention on Psychotropic Substances are included in the system. Reports are generated on quantities imported, exported, locally produced, used in manufacture and distributed. The result is that the risk of diversion has been reduced to a minimum. Information obtained from the system has proved of considerable assistance in fulfilling Australia's international treaty obligations.

Australia↗

PubMed2003

[A study on formulas of Ettyu-Hangontan during the Edo period].

Since 1640, Borneol was brought to Nagasaki from South-East Asia by the Dutch ships. As a result, it was introduced as a component unique to "Hangontan" which was distributed by the pill-peddler of Toyama during the Edo period. We intend to discuss how to bring about such a formula for the "Hangontan" of Toyama.

Asia, Southeastern↗

PubMed2004

Multilingualism and healthcare in Nigeria: a management perspective.

Nigeria has a healthcare system that has been described as defective even by its managers. A year 2000 study by the World Health Organization (WHO) of health systems in 191 member countries ranked Nigeria 187th. These several evaluations consistently point to inadequate managerial skills. Regrettably, very little is known of the import of language and communication as management issues in healthcare delivery in this country of 400 languages. This article therefore proposes a language-driven audit of health management in Borno State (northeast Nigeria) as a means of sensitizing policy makers and implementers. Based largely on data from questionnaires completed by 129 health professionals belonging to various professional categories (physicians, nurses, pharmacy staff, laboratory staff, and medical and health workers) and drawn from four hospitals, the study explores the relationship between multilingualism and the following: (a) patients' rights; (b) staff recruitment, deployment and commitment; (c) human asset accounting; (d) physician-population ratio. This language-driven audit reveals a number of points, including: ethically questionable practices; distributional imbalance in personnel; commendable cases of employee commitment; and inequity in renumeration.

Communication Barriers↗

PubMed2002

Bioavailability study of tablet Bezafibrate 200 mg (Lipocor).

In order to determine the ultimate quality of any formulated dosage form and rationalize the therapeutic plan as well as to individualize the prescription, in vivo measurement of drug is the modem and specialized expertise of the clinical/research area of pharmacy practice, which provides effectiveness and assures the safety of drugs. All pharmacological, therapeutic or toxic responses are subject to reaching of drug at the site of action through connective tissue. Other than physico chemical properties of drug, there are numerous factors from manufacturing process to biochemical behaviour of the individual which resist in the absorption, distribution, metabolism and elimination of drugs in the biological system. Bezafibrate Tablet 200 mg (Lipocor) an oral conventional formulation manufactured by Efroze Chemical Industries (Pvt.) Ltd. was investigated for bioavailability followed by pharmacokinetic studies on adult, male, healthy, human local population. For this purpose, a sensitive, specific and validated method was used for the estimation of bezafibrate in blood. HPLC was performed on a reversed phase C18 column (flow rate 1.5 ml/min, UV = 230 nm) with 0.02 M buffer of KH2PO4 (Adjusted pH 3.5 with Phosphoric Acid) and Methanol (40: 60) whereas extraction of the drug from the plasma was carried out by deproteinization of plasma according to classical method described in previous studies (Obaid A. et al., 1999). Peak level (Tmax) of Bezafibrate Tablet 200 mg (Lipocor) was observed at about 1.42 +/- 0.53 hours after the dose and practically free Bezafibrate Tablet 200 mg (Lipocor) could be detected in blood after 9 hours. Cmax of the investigated formulation of Lipocor register mark or target was 1732 +/- 374.2 ng/ml. Area under curve (AUC) was 5198.65 +/- 1231.8 ng. hr/ml.

Journal Article↗

PubMed2000

Transitions in pharmacy practice, part 5: walking the tightrope of change.

A systematic process for reformulating the practice-related attitudes and values of pharmacists to help them adapt to a new practice model is described. The key to motivating pharmacists to commit to practice change lies in fostering a change in intrinsically held professional attitudes and values, not in emphasizing a structured extrinsic reward system. As a systematic process by which managers can motivate their staff to change attitudes and values, the authors offer a customization of the taxonomy of learning in the affective domain proposed by Krathwohl, supplemented by contributions from the literature on the diffusion of innovation, dissonance theory, the transtheoretical model, and instructional psychology. Krathwohl's taxonomy shows affective learning as a five-level hierarchy with stages within each level. Managers can guide practitioners through the first four levels. Practitioners who have been socialized for the distributive model and who then adopt a new practice model such as pharmaceutical care will start by simply receiving information about the new model. Next, they will actively respond to learning about the model and begin to value it as desirable. As their regard for the new model grows, they will reorganize practice priorities. Managers can help pharmacists adopt a new practice model by guiding them through stages of attitude and value formation.

Models, Organizational↗

PubMed2004

Predicting resource utilization in a Veterans Health Administration primary care population: comparison of methods based on diagnoses and medications.

BACKGROUND: Valid methods of predicting resource utilization in primary care populations are needed. We compared the predictive validity of a method based on diagnoses from administrative data (Adjusted Clinical Groups [ACGs]) and a method using medication profiles (Chronic Disease Index [CDI]). METHODS: This retrospective cohort study included 31,212 primary care patients in a Veterans Health Administration (VA) network who received outpatient medication prescriptions in 1999 and who had VA utilization in 1999 and 2000. ACG and CDI classifications were determined using 1999 data. Analyses compared the predictive validity with respect to outpatient clinic visits and days of hospital care. RESULTS: Both ACGs and CDI explained a higher proportion of the variance in outpatient visits than demographic data alone. However, explained variance was higher for ACGs. For example, ACGs explained 30.2% of the variance in total visits in 1999, compared with 8.8% for the CDI. Results were similar for 2000, although the explained variance declined for both methods (eg, 16.3% and 5.7%, respectively, for total visits). Results were similar in analyses examining the discrimination of the 2 methods to predict hospital use; for example, c statistics for ACGs and CDI scores were 0.86 versus 0.70, respectively (P <0.05), for 1999 and 0.72 and 0.65, respectively (P <0.05), for 2000. CONCLUSION: Among VA patients, ACGs had superior predictive validity than the CDI, a newer nonproprietary method based on pharmacy data. The findings suggest that diagnosis-based measures could be preferable for ambulatory case-mix adjustment and are valid across a wide range of populations.

Age Distribution↗

PubMed2004

Profile of medical charges for children by health status group and severity level in a Washington State Health Plan.

OBJECTIVE: To identify children and evaluate patterns of charges for pediatric medical care, by overall health status, severity of illness, and categories of medical service. Data Sources Enrollment, claims, and charges data from a Washington State health plan. The study population includes all children ages 0 to 18 years during calendar year 1999. STUDY DESIGN: Children were classified into clinically defined health status groups and severity levels using Clinical Risk Groups (CRGs). Health plan charges were analyzed according to core health status group, severity level, and category of service. DATA COLLECTION: The three secondary data sources were obtained electronically from the health plan and cleaned for unique members and data quality before analysis. PRINCIPAL FINDINGS: Children classified as healthy (85.2 percent) had mean and median annual charges of dollar 485 and dollar 191. Children with one or more chronic conditions (9.5 percent) had mean and median charges increasing by status and severity group from dollar 2,303 to dollar 76,143 and from dollar 1,151 to dollar 19,456, and accounted for 45.2 percent of all charges. Distribution of charges varied across health status groups. Healthy children had 70.6 percent of their charges in outpatient and physician services. Children classified in the complex, catastrophic, and malignancy groups had 67 percent of their charges in inpatient encounters. Children with chronic conditions accounted for 31.8 percent of all physician, 41.8 percent of outpatient, 47.7 percent of pharmacy, 60.7 percent of inpatient, and 75.8 percent of all other charges. CONCLUSIONS: Children with chronic conditions account for a disproportionately high percentage of children's health expenditures. They account for different percentages of expenses for different medical services. These percentages vary according to health status and severity. This analysis can be used to identify and track groups of children for various purposes.

Adolescent↗

PubMed2002

Repeated point prevalence survey of nosocomial infections in a Greek university hospital.

Two point prevalence surveys of nosocomial infections (NIs) were carried out in a Greek University hospital on an annual basis in 1998 and 1999. The overall prevalence of NIs was 9.5% and 9.1% in the first and second study, respectively. The average length of stay of patients in the hospital (ALOS) was 7.7 and 9.6 days in these two studies, respectively. Of the 97 NIs detected, the most frequent were lower respiratory tract infections (36%). Urinary tract infections, bloodstream infections, surgical site infections, and gastrointestinal infections were found in 25.8%, 19.6%, 7.2% and 4.1% of patients, respectively. The prevalence of antibiotic usage was 55.6% in 1998 and 54.1% in 1999. Empiric antibiotic therapy prevailed over prophylactic and rational therapies. These percentages are higher than those reported from other countries, emphasizing the need for rational antibiotic usage to decrease pharmacy expenses and discourage the development of resistant microorganisms. A nationwide network of surveillance of NIs in Greece is now being developed using these experiences.

Adolescent↗