Effectiveness of an ambulatory care clinical pharmacist: a controlled trial

Medical therapy for duodenal or gastric ulcer disease has traditionally involved gastric acid antisecretory therapy for 4 to 8 weeks to promote initial healing and indefinitely to prevent recurrences of ulcer. The discovery of Helicobacter pylori in most patients with peptic ulcer disease has led to a change in this approach. Therapy designed to eradicate H pylori may facilitate ulcer healing with acid antisecretory agents and, more important, may greatly reduce the incidence of ulcer recurrence, obviating the need for maintenance antisecretory therapy. Regimens designed to eradicate H pylori are difficult to comply with, however, and are associated with adverse effects in some patients. In this article we review the diagnosis and treatment of H pylori infection in patients with peptic ulcer disease and make recommendations regarding the use of conventional ulcer therapies and therapies designed to eradicate H pylori.     

Management of abusive behaviour in a hemodialysis unit

We present four clinical cases where eosinophilia was a prominent sign. Final Diagnoses were Toxocariasis, Ascaris Lumbricoides Infection, Acute Lymphocytic Leukaemia and Histiocytosis of Langerhans Cells.     

The cost-effectiveness of a clinical pharmacist intervention among elderly outpatients

We report the close correlation between changes in serum immunoreactive vascular endothelial growth factor 165 (iVEGF165) levels and metastatic tumor burden measured by computed tomography scan before treatment, during the antitumor response, and during early progression in a patient treated with ex vivo gene therapy for renal cell carcinoma. With the researcher blinded to outcome, iVEGF levels were measured in archived serum samples from a patient with metastatic renal cell carcinoma who demonstrated a 7-month partial remission to treatment with autologous, irradiated human GM-CSF gene transduced tumor vaccine. Although a spontaneous regression could not be formally excluded in this patient, the appearance of 20 new pulmonary metastases on computed tomography scan after nephrectomy and before vaccination indicates that if spontaneous regression occurred, it took place at the start of vaccine treatment.     

Effectiveness of interventions to improve patient compliance: a meta-analysis

OBJECTIVES: This article summarizes the results of 153 studies published between 1977 and 1994 that evaluated the effectiveness of interventions to improve patient compliance with medical regimens. METHODS: The compliance interventions were classified by theoretical focus into educational, behavioral, and affective categories within which specific intervention strategies were further distinguished. The compliance indicators broadly represent five classes of compliance-related assessments: (1) health outcomes (eg, blood pressure and hospitalization), (2) direct indicators (eg, urine and blood tracers and weight change), (3) indirect indicators (eg, pill count and refill records), (4) subjective report (eg, patients' or others' reports), and (5) utilization (appointment making and keeping and use of preventive services). An effect size (ES) r, defined as Fisher's Z transformation of the Pearson correlation coefficient, representing the association between each intervention (intervention versus control) and compliance measure was calculated. Both an unweighted and weighted r were calculated because of large sample size variation, and a combined probability across studies was calculated. RESULTS: The interventions produced significant effects for all the compliance indicators (combined Z values more than 5 and less than 32), with the magnitude of effects ranging from small to large. The largest effects (unweighted) were evident for refill records and pill counts and in blood/urine and weight change studies. Although smaller in magnitude, compliance effects were evident for improved health outcomes and utilization. Chronic disease patients, including those with diabetes and hypertension, as well as cancer patients and those with mental health problems especially benefited from interventions. CONCLUSIONS: No single strategy or programmatic focus showed any clear advantage compared with another. Comprehensive interventions combining cognitive, behavioral, and affective components were more effective than single-focus interventions.     

Effectiveness of public health interventions in food safety: a systematic review

Reflective practice is now widely debated as a means of improving nursing practice. However, assumptions about reflective practice are rarely clarified and seldom subjected to critique. Therefore, the purpose of this paper is to take up Clarke, James & Kelly's suggestion that limits to the scope and depth of reflection be considered. This is achieved by reflecting on what these authors claim it means to reflect in action. Four arguments are presented: (i) that nurses cannot be conscious of all aspects of nursing practice because there are aspects of practice that cannot be represented in consiousness, (ii) that those aspects of practice that can be represented in consciousness can be so only imperfectly, (iii) that all such representations are not reflexive, and (iv) that any representation in the form of an internal dialogue that could be regarded as reflection is overdetermined. Implications for reflexivity are then considered.     

Impact of pharmacist interventions on medication management by the elderly: a review of the literature

OBJECTIVE: To review the impact of pharmacist interventions designed to assist older people in managing their medication regimens. DATA SOURCES: A computer search of literature published between 1975 and 1990 was conducted using MEDLINE. References were also identified from the bibliographies of pertinent articles. STUDY SELECTION: Studies included in the review were those evaluating pharmacist interventions that were designed to assist in medication management by people over 65 years of age. Only nine studies were identified by these criteria. Interventions that have not been evaluated are discussed briefly. The studies included were chosen by consensus of the authors. DATA EXTRACTION: A data extraction form was used to summarize the information in each study. RESULTS: This was a qualitative review. Some studies evaluating the effects of short verbal medication counseling episodes showed positive benefits; others showed no benefit. Written medication information, some memory devices, and audiovisual techniques have also been found to be of limited use. Self-medication programs for hospitalized elderly people need to be evaluated. CONCLUSIONS: This review identified the lack of published evaluations of pharmacist interventions in medication management by elderly people. Well-designed studies need to be performed to determine the effects of individualized advice and counseling. The cost-effectiveness of such interventions should be assessed, with consideration of long-term outcomes, such as readmission rates to the hospital and cost savings accruing from increased duration of independent living.     

A psychopharmacology education program for psychiatry residents--the role of a clinical pharmacist

From April, 1983 to March, 1993, 63 patients (pts) underwent reoperations of valvular heart disease at Tokyo Medical and Dental University Hospital, of which 44 pts had undergone closed mitral commissurotomy (CMC), open aortic or mitral commissurotomy (OAC or OMC) or valvuloplasty, and 17 pts had undergone aortic or mitral valve replacement (AVR or MVR). Valve replacement was performed in 59 pts (mechanical valve replacement; 42 pts, porcine valve replacement; 12 pts), and 2 pts received OMC due to restenosis after CMC. Preoperative diagnosis included restenosis after CMC, OMC or valvuloplasty in 43 pts, bioprosthetic dysfunction after MVR in 10 pts, perivalvular leakage after AVR in 1 pt, valve detachment after AVR in 4 pts (Be?het 3 pts, infective endocarditis 1 pts). Valve replacement or valvuloplasty was done for another valves in addition to the previously operated valve in 44 pts (72.1%), especially for tricuspid valve. Restenosis after CMC, occurred at 20.6 years after surgery, and restenosis after OMC and valvuloplasty at 13.1 years. Bioprosthetic dysfunction after MVR occurred at 8.5 years. Valve dysfunction of the mechanical valve was not observed. The early operative mortality after reoperations was 11.5% (7 pts) in this series. And 3 pts (4.9%) died in the late follow-up due to cancer in 1 pt and congestive heart failure in 2 pts. A first choice of mechanical valve for redo valve replacement for aortic/mitral valve, and modified AVR using composite graft and proximal double fixation to the fragile annulus seemed to be satisfactory to accomplish better operative results.     

Effectiveness of HIV interventions among women drug users

A prospective cohort study was conducted among chronic injecting and crack cocaine drug using women. The hypothesis tested was that participation in a standard-plus-innovative intervention was more likely to produce behavior change than participation in a standard intervention. Standardized intervention protocols and corresponding instruments were designed. Data were collected on drug and sex risk behaviors at baseline and six-month follow-up intervals. The level of behavioral change in two intervention arms--standard and a standard-plus-innovative intervention--was measured by composite sex risk and drug risk scores using the generalized estimating equation approach. The results show that on four risk measures the enhanced intervention was significantly associated with positive change in both drug use and sexual behavior: less frequent drug use, less drug use during sex, and more frequent condom use during particular frequencies for specific types of sexual activities. Public health interventions are effective when targeting specific risk behaviors through interventions tailored to prevent HIV and reduce risk behaviors among specific cultural and gender groups.     

Use of a purse string suture to close a percutaneous access site after hemodialysis graft interventions

BACKGROUND: Weekend therapy with superpotent topical corticosteroids has been used for the long-term treatment of psoriasis. Recently, calcipotriene ointment has been added to this regimen for use on weekdays, but there are no long-term studies of that combination. OBJECTIVE: The purpose of this study was to determine whether the addition of weekday calcipotriene to a pulse therapy regimen of weekend superpotent corticosteroids results in a longer duration of remission of plaque psoriasis. SUBJECTS: This was a double-blind, placebo-controlled, parallel-group study. Forty-four patients with mild to moderate psoriasis were treated with calcipotriene ointment in the morning and halobetasol ointment in the evening for 2 weeks. Thereafter, 40 patients who were at least moderately (50% or greater) improved were randomized to 2 treatment groups. After 2 weeks of treatment with calcipotriene ointment in the morning and halobetasol ointment in the evening, 20 patients were randomized to receive halobetasol ointment twice daily on weekends and calcipotriene ointment twice daily on weekdays, and 20 patients were randomized to receive halobetasol ointment twice daily on weekends and placebo ointment twice daily on weekdays. RESULTS: Seventy-six percent of patients applying halobetasol ointments on weekends and calcipotriene ointment on weekdays were able to maintain remission for 6 months compared with 40% of patients applying halobetasol ointment on weekends only with the vehicle on weekdays. CONCLUSION: The addition of calcipotriene ointment applied on weekdays to a weekend pulse therapy regimen of superpotent corticosteroids can increase the duration of remission of psoriasis.     

Effect of pharmacist interventions on medication use and cost in hospitalized patients with or without HIV infection

Pharmacotherapeutic interventions and drug acquisition costs in HIV-positive and HIV-negative patients on a hospital medical service were studied. In November and December 1995, HIV-positive and HIV-negative patients were randomly selected and matched on the basis of admission date. Pharmacotherapeutic interventions were recorded by a pharmacist until the time of discharge. Drug acquisition costs were obtained through records of medications ordered. The two patient groups were compared with respect to length of stay (LOS), number and cost of medications, and number of interventions. HIV-positive patients had significantly more medication orders and required more interventions than HIV-negative patients. Mean LOS was not significantly different. HIV status and number of medications were significantly associated with requiring five or more interventions. Drug acquisition costs were significantly higher in the HIV-positive group. The mean pharmacist-attributed cost saving per patient was $134 for HIV-positive patients and $27 for HIV-negative patients. HIV-positive patients required more interventions and consumed more medication resources than HIV-negative patients. Pharmacist interventions produced drug acquisition cost savings for both groups, with more savings being realized for positive patients.     

Psychotherapeutic interventions in physical health: Effectiveness and economic efficiency.

Reviews the literature to determine (a) whether psychotherapy exerts a favorable influence on physical health, and (b) whether psychotherapy can be employed to change physical health on a cost-effective basis. Research with overutilizers of medical services, surgical patients, and other groups is discussed in terms of methodological adequacy, and problems faced by researchers in these areas are explored. The effectiveness and economic efficiency of psychotherapeutic preparation for surgery is strongly supported. Studies with overutilizers are promising, but randomized experiments are needed. Implications for inclusion of coverage of psychotherapy under national health insurance are discussed. (2? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Calculation of tissue attenuation with a clinical ultrasound unit

RATIONALE AND OBJECTIVES: Five alternative methods for estimating tissue attenuation with a clinical ultrasound unit were evaluated. METHODS: Two homogeneous tissue mimicking phantoms (with known attenuations of 0.25 and 0.54 db/cm/MHz) and 22 human placentas were scanned. Attenuation coefficients were computed by linear regression of 1) L(f), the log spectral difference; 2) Fav (d), the average spectral frequency; 3) log[P(d)], the logarithm of the spectral power; 4) Fav (d) x log[P(d)]; and 5) (Fav(d) + log[P(d)])/2. RESULTS: Each of these five heuristics provided accurate estimates for the relative attenuations of the two phantoms. For placental tissue, method 3 provided better regression fits than methods 1 and 2. Methods 4 and 5 provide the best regression fits (P < .01). CONCLUSIONS: The combination of both frequency and power information in methods 4 and 5 compensates, in part, for nonlinearities introduced by tissue heterogeneity. A parameter that combines both frequency and time domain information is likely to provide more reliable estimates of attenuation than power or frequency measurements alone.     

Treating fluid noncompliance in the hemodialysis population using unit wide contests

Thirty-six patients with tinea unguium were treated with 200 mg of itraconazole daily for 7 days each month. We suggested that a patient who had a lesion in the thumbnail needed 5 months of treatment for mycologial cure, while in a patient without thumbnail lesion, 3 months of treatment was enough.     

探讨药师合理应用抗菌药物的临床要点

目的:探讨临床药师如何在医院抗菌药的合理用药中发挥作用.方法:临床药师通过参与抗菌药物合理使用监测、制定抗菌药物临床应用实施细则、临床查房、开展药学讲座等方法,开展药学服务.结果:规范了医院抗菌药物的预防使用,使临床抗感染疗效大为提高.结论:临床药师积极参与临床药学服务,促进了医院抗菌药物的合理、安全使用.     

Effectiveness of a pneumonia clinical pathway: quality and financial outcomes

In today's health care environment, it is imperative to evaluate planned changes within a health care system. We report the outcomes of a study on the effectiveness of a pneumonia clinical pathway. Important elements of effectiveness studies are discussed and used in presenting study findings. These findings are a preliminary demonstration that clinical pathways can improve patient and process outcomes. Their relation to financial outcomes is less clear.