Computer software for pharmacy oncology services

A computer program designed to manage the informational, clinical, and data requirements for a pharmacy oncology service is described. Specialized pharmacy oncology software was developed at Rhode Island Hospital and implemented in a multihospital, integrated health system. The software performs various safety functions, supplies on-screen access to pertinent drug and patient information, manages data, and assists in the product formulation process. The programmed safeguards can be modified to meet changing requirements. The system has been in use for more than seven years and has helped detect prescribing errors and prevent preparation and administration errors. A pharmacy oncology computer program streamlines pharmacists' work and helps prevent errors in antineoplastic drug therapy.     

Prescribing practice and policy for hypnotics: a model of pharmacy audit

A problem of overprescribing of hypnotic medication ('sleeping tablets') was identified and quantified within a department of health care for older people in a district general hospital. Data on the volume of prescribing were obtained from computerized pharmacy records, and this information was supplemented by a retrospective survey of case notes of 100 patients. Sixty per cent of patients were prescribed a hypnotic at some stage during their hospital stay. Twelve per cent were prescribed a sleeping tablet on admission on an 'as required' basis but never took this medication, suggesting that such prescribing was becoming routine. As part of an ongoing pharmacy audit within the department, a policy was implemented to try to improve prescribing habits. Following this, hypnotic prescribing fell, with the average monthly number of sleeping tablets prescribed falling from 2392 to 734. A further survey of 100 case notes showed overall prescribing had fallen to 25%, although 2% were still prescribed a hypnotic on admission but never took it.     

The perceived influence of clinical pharmacy services on physician prescribing behavior: a matched-pair comparison of pharmacists and physicians

In contrast with cross-sectional designs used in previous studies, this exploratory study compared survey data from 127 matched pairs of clinical pharmacists and physicians working together. Physicians' perceptions of the importance of clinical pharmacy activities for patient care and the competence of pharmacists performing the activities were examined for their influence on prescribing behavior in an institutional setting. Data from a national survey showed that physicians rated pharmacists higher regarding recommendations based on drug use evaluations (p = 0.004) and competency to provide all clinical pharmacy services. Scores for pharmacokinetics ratings were similar between pharmacists and physicians (p = 0.168). Pharmacists rated the importance of recommendations based on cost-effectiveness higher than physicians (p = 0.012). Overall, physicians' perceptions of activity importance for patient care and pharmacist competency appear to dictate pharmacists' influence on physician prescribing behavior (R = 0.723).     

Phenomenologies as research methodologies for nursing: from philosophy to researching practice

The effects of synthetic tetrahydrocannabinol (THC) on event-related brain potentials (ERPs) were assessed in 19 healthy male volunteers while they performed a visual continuous word recognition task. The study used a double-blind cross-over design. Specifically, word lists were manipulated to contain an equal number of emotionally neutral, negative, and positive words. Most words were repeated after several intervening items with the subject's task to classify each word as old (previously seen) or new. Behaviorally, a decrease in recognition rate was observed under THC but no influence of the emotional charge of a word on recognition rate was seen. The ERPs showed a typical difference between old and new words taking the form of an enhanced positivity for old words beginning 250 ms poststimulus. The effects of THC were confined to the positive words, for which an enhancement of the positivity to the old words was seen. This effect was interpreted in terms of a congruity of the drug-induced mood state and the material to be recognized. The dissociation between ERPs and behavioral indices suggested that the former primarily reflect implicit memory processes.     

Children''s palliative care services: implications for everyone''s practice

When the time came for Enid to make the transition into long term care the profile of Enid with her biography and behaviour modes was passed on to staff in the nursing home, thus enabling them to start from a point of knowing Enid as an individual. During her time at Burford, Enid managed to communicate and express herself sufficiently to keep a good degree of self-agency. Her dementia mapping scores showed her to be generally in a state of well-being. This article has attempted to show how it is possible to listen and learn from people with dementia and that care staff must want to learn about and from the person with dementia if they are to care for them in a person centred way.     

Collaborative practice in pharmacy: Substance or semantics?

Medication use has become increasingly complex with expanding numbers of medications and growing populations of chronically ill patients. Changes in state and federal law and regulation have attempted to keep pace with the need for health care practitioners to oversee safe and effective medication use in various patient populations, including recent changes in Medicare. Pharmacists have experienced significant advancement in their education as well as in the roles they play in acute and chronic health care delivery. Over 44 states now recognize pharmacists' collaborative practice authority that allows for the initiation, monitoring, and modification of medication therapy for patients, typically under protocol. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Capitated reimbursement for medical services returns control of the patient to the surgeon

Limiting the spending on healthcare services is a societal necessity, whether externally budget-driven with reduced fee for service or salary, or internally controlled through prospective payment capitation. No reimbursement system is inherently good or bad. Ethical physicians will place patient well-being first and focus on the delivery of quality care, regardless of the payment method. There are several methods for the distribution of capitation payments to physicians, each with different levels of financial incentive to provide services. In one fully evolved embodiment of capitation, a payer carves out the entire orthopedic disease segment and contracts with an orthopedic organization for all musculoskeletal services within a defined geographic region. This form of capitation offers the advantage of returning control of patient care to the orthopedic surgeon.     

Family pharmacy and family medicine: a viable private practice alliance

The association of the new roles of the family physician and the family pharmacist in a model private practice is described. The pharmacist works closely with the family physician to offer personalized patient education and follow-up for therapeutic effectiveness. He also serves as a consultant to the physician for up-to-date drug information and assists in solving difficult therapeutic problems. Reimbursement for pharmacy services occurs for consultative time as well as by traditional methods. Initial response by the professionals themselves as well as the patients and staff has been very positive. An appropriate physical plant and ongoing communication between physician and pharmacist are mandatory for the success of this model. Some specifics of this practice at its present stage of development are included.     

循证药学在碳青霉烯类药物临床应用的研究

目的:为解决临床用药问题,查找循证医学及循证药学证据,比较亚胺培南和美罗培南的安全性以及美罗培南的输注方法改进.方法:检索数据库,查找相关的系统评价,随机对照实验等,并对所获得的证据进行质量评价.结果:美罗培南的肝损害发生率比亚胺培南略高,并且不良反应与药物应用剂量无关.结论:采用美罗培南对难治性耐药菌应3h连续静脉滴注有较好效果.     

Guidelines for clinical practice

Clinical practice guidelines are systematically developed statements that are intended to support medical decision making in well-defined clinical situations. Essentially, their object is to reduce the variability in medical practice, to improve quality, and to make appropriated control of the financial resources possible. Internationally, ever more organisations, associations, and institutions are concerned with the development of guidelines in many different areas of care. Making implicit knowledge explicit is one of the associated advantages of guidelines: they have a potential utility in training, in process evaluation, and in the reevaluation of outcome studies. In liability issues, their existence has a double effect: they can be used to justify medical behaviour, and they constitute a generally accepted reference point. A derivative problem is the legal liability of the compilers of the guidelines. The principle of the guideline approach can be challenged academically: science cannot give a definition of optimal care with absolute certainty. What is called objectivity often rests on methodologically disputable analyses; also the opinion of opinion leaders is not always a guarantee for scientific soundness. Moreover, patients are not all identical: biological variability, situational factors, patient expectations, and other elements play a role in this differentiation. Clinicians are often hesitant with respect to clinical guidelines: they are afraid of cookbook medicine and curtailment of their professional autonomy. Patients fear reduction of individualization of care and the use of guidelines as a rationing instrument. The effects of the introduction of clinical practice guidelines on medical practice, on the results and on the cost of care vary but are generally considered to be favourable. The choice of appropriate strategies in development, dissemination, and implementation turns out to be of critical importance. The article ends with concrete suggestions for the various steps in the development of guidelines and their actual compilation.     

The evolution of change: from nurse auditor to clinical reimbursement specialist

The effect of administration of cadmium alone in non-irradiated mice as well as the effect of pre-irradiation administration of cadmium on the reparation processes of haemopoiesis were investigated in mice irradiated by a dose of 7.5 Gy. The pre-irradiation administration of cadmium accelerated the reparation processes in the bone marrow and spleen as well as the number of leukocytes and thrombocytes in the peripheral blood. The administration of cadmium alone caused a temporary weight decrease of the thymus and reduced number of erythrocytes, reticulocytes and haemoglobin values in the peripheral blood. The temporary rapid increase in the number of leukocytes on the 21st day after cadmium administration was investigated.     

The practice of psychological testing in clinical services in the United States.

Questionnaire responses were obtained from 185 (61% of 304 agencies including VA stations, state mental hospitals, institutions for mental defectives, outpatient clinics, and counseling centers. The median number of different tests was used 26; the range was from 5 to 8. The most frequently used tests are the Rorschach, Draw-A-Person (Machover), Thematic Apperception Test, Visual Motor Gestalt Test (Bender), Stanford-Binet, WAIS, and MMPI in that order. Comparisons are made of the 20 most used psychological tests in each of 3 decades. From Psyc Abstracts 36:02:2HA79S. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Logotherapy for clinical practice.

Logotherapy is based on the meaning-focused existential philosophy of Viktor E. Frankl (1905-1997). Numerous mental health professionals have been inspired by his most popular book, Man's Search for Meaning; however, many are unfamiliar with the depth of Frankl's work. The purpose of this article is to discuss the tenets of logotherapy, including fundamental concepts, applicability and techniques, roles of the therapist, and assessment tools and new research findings. Logotherapy can readily be integrated with techniques that mental health professionals frequently use, and thus it has much to offer mental health professionals regardless of their theoretical orientation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)