bluuebunny/crossref_metadata_2025 huggingface dataset:
Resource Allocation Modelling for Home-Based Health and Social Care Services in Areas Having Differential Population Density Levels: A Case Study in Northern Ireland
Authors: Hindle Tony , Hindle Adam , Spollen Martin
Published: January 2017

This project arose from deliberations within the Department of Health and Social Services (DHSS) in Northern Ireland concerning the acceptability of the revenue resource allocation methodology they were using. One problem with the method being used had been the absence of a component that adequately reflected the relative costs associated with the differential population densities of the four health boards into which the Province is divided. This study investigates a particular element of this issue, viz differences in the travelling distances and times of those health and social service professionals who provide visiting services to patients in their own homes. A modelling approach has been developed and used in conjunction with a comprehensive spatial and geographical information system for Northern Ireland. An important outcome of the study has been estimates of the targets that should be set for the annual health and social care travelling distances and times per head of population in the boards, for a range of home-based services. Also, the project has contributed to decisions made by the DHSS in Northern Ireland concerning the annual financial compensations required by boards for costs associated with their relative population densities.
Options Analysis of Managed Care Contracting and Regulation: Theory and Evidence
Authors: McLean R. A. , Magiera F. T.
Published: January 2017

Managed care contracts can be represented as bundles of options. In particular, the managed care provider is short a call option. To hedge the risk involved in such contracts, managed care contractors can construct several types of virtual put options, among them the ownership of facilities. Agency theory and options theory suggest that for-profit managed care plans, in the presence of debt, will engage in less hedging activity than will other managed care plans. Here, the authors test that hypothesis, using data for Florida HMOs in 1995, and they reject the null hypothesis. That managed care organizations act as if they are short a call option raises interesting regulatory issues, including the possibility of using a hedge-based regulatory scheme in place of a net-worth-based scheme.
Impact of the Griffiths Reforms of National Health Service Management: The Views of Psychiatrists
Authors: Harrison Stephen
Published: January 2017

The Griffiths Report of 1983 recommended a number of reforms to the management of the National Health Service. These were strongly opposed in principle by the British Medical Association though some physicians saw them as potentially beneficial. This paper reports a survey of Psychiatrists in one English Region, whose responses suggest that although there remains little opposition in principle and respondents do see some beneficial effects, the new system tends to be seen in terms of its pragmatic disadvantages, with special reference to a perceived lack of managers' understanding of patients' needs.
The Design and Implementation of a Management Information System for Australian Public Hospitals
Authors: Stoelwinder Johannes U. , Abernethy Margaret A.
Published: January 2017

Existing management information systems (MIS) in hospitals are often inadequate. This has occurred because of a variety of antecedents, including past funding mechanisms, organisational structure and the accepted role of management. A variety of new pressures, including demands for increased accountability, greater resource control and changing relationships between physicians and hospitals are demanding improved MIS to enable the hospital to manage.

This paper explores these influences on past and future hospital MIS. It describes the design of a MIS that enables patient care to be costed in clinically meaningful ways. Patient costs may be aggregated to cost specific diagnoses and procedures, Diagnosis Related Groups (DRG), a clinician's case load, a clinical unit or a division. The information can be used for clinical budgeting, flexible budgeting, utilisation review and quality assurance.
A Conceptual Framework for Evaluating Joint Venture Opportunities between Hospitals and Physicians
Authors: Jacobson Carol K.
Published: January 2017

A Conceptual Framework for Evaluating Joint Venture Opportunities Between Hospitals and Physicians

This paper reviews the changes in the competitive and regulatory environment and examines the impact of those changes on the relationships between hospitals and physicians. Transaction cost economics (TCE) provides a conceptual framework for examining the emergence of closer linkages between hospitals and physicians than the traditional independent hospital and medical staff organisations. TCE predicts that as investments in support of transactions become more specialised, closer linkages are more efficient. To illustrate, two case studies of successful hospital-physician joint ventures are presented. The first case study describes a joint venture between hospitals and physicians to purchase durable medical equipment. The second case describes the breakdown of an informal arrangement and the subsequent formation of a joint venture to organise a clinical programme. The discussion reports the rationale for choosing these structural arrangements and their key features, pointing out how TCE would account for the decision to establish a joint venture. The conclusion discusses the implications of this argument for the strategic decisions of health care managers.
Keeping up with the Joneses: The Influence of Public and Proprietary Neighbours on Voluntary Hospitals
Authors: Hughes Robert G. , Luft Harold S.
Published: January 2017

Individual hospitals often share their markets with other nearby hospitals. In this paper we examine how a hospital's ownership and the ownership of its hospital neighbours influence the availability of selected services. The presence of a CT scanner and a newborn nursery were found to be associated with both hospital ownership (voluntary, proprietary, or public) and with the ownership of hospital neighbours. Voluntary hospitals with a proprietary neighbour were more likely to have a CT scanner. These findings suggest that the ownership configuration of local hospital markets is an important influence on patterns of service availability.
Hospital CEO Turnover: Modelling More or Less Durable Places to Work
Authors: Weil Peter , Timmerberg John
Published: January 2017

This study documents the rising rate of hospital CEO turnovers between 1978 and 1988, a trend that has accelerated since the introduction of Medicare's prospective payment system. Using data from the American Hospital Association, we identify characteristics of hospitals experiencing rapid CEO turnover. Results show that full utilization along with a positive operating margin can prolong the CEO's tenure but ownership and system membership specify the findings.

For example, CEO turnover is higher in investor-owned, multihospital systems hospitals if they are small, if their costs are high and if they have recently joined a multi-hospital system. By contrast, in not-for-profit multihospital systems, turnover is higher if they have low occupancy and low operating margins.

CEO turnover in not-for-profit, freestanding hospitals is higher in metropolitan areas and in the Western region of the US as well as in hospitals with low occupancy, low operating margins and lower costs per patient day. Governmental hospitals experiencing higher CEO turnover are small, metropolitan and tend to be located in any region except the Midwest. Many have recently joined a multi-hospital system and have experienced low operating margins.
Organizational Assessment: Concept, Method and Application
Authors: Brown Gordon D. , Kaluzny Arnold D.
Published: January 2017

The concept of organizational assessment of health institutions is explored in terms of why it is becoming increasingly popular, alternative approaches, and its potential as a tool for quality assurance or program evaluation. There is an outline of an approach to developing standardized performance criteria and a design for carrying out an assessment through a self-assessment method. Illustrations of the application of the model are included.
Bed Size and System Influence on Financial Structure: A Time-Series and Cross-Sectional Analysis of California Hospitals
Authors: McCue Michael J.
Published: January 2017

Using California hospitals, this study examines both on a cross-sectional and time-series basis the influence bed size and system affiliation have on financial structure. Specifically, the study classifies these hospitals into eight bed size and system categories ranging from less than 100 bed, free-standing hospitals to over 400 bed, system-affiliated hospitals. Somewhat unexpectedly, the results did show that the total debt ratio for smaller, free-standing hospitals did not differ statistically from larger free-standing and system hospitals. However, smaller system-affiliated hospitals did have higher total and long-term debt ratios than larger, system-affiliated and free-standing hospitals.
Corporate Structure and Administrators' Job Stress: The Case of Nursing Homes
Authors: McGee Gail W. , Fottler Myron D. , Shewchuk Richard M. , Giardina Carole W.
Published: January 2017

This paper examined the relationship between the job-related stress of nursing home administrators and the structure of their work setting. Multivariate analysis of covariance (MANCOVA) was used to test the hypothesis that nursing home administrators who are employed in multi-unit, corporate-owned facilities experience more job-related stress than do administrators employed in independent, free-standing organizations. The results indicated that, when controlling for other potential stressors, administrators in corporate-owned nursing homes reported more general job stress and greater role ambiguity than their counterparts in single-unit, autonomous organizations. Recommendations for management strategies and for future studies in this area are discussed.
Human Immunodeficiency Virus Infection and Syphilis in Hondurian Female Prostitutes
Authors: Venegas Vilma Susana , Madrid Juan Paz , Lorenzana Ivette , Grillner Lena , Cosenza Humberto , Bygdeman Solgun
Published: January 2017

The seroprevalence of human immunodeficiency virus (HIV) infection and syphilis was investigated in 181 female prostitutes in Tegucigalpa, Honduras. One particle agglutination test and two enzyme immunoassays, as well as one immunofluorescence test were used for the screening of HIV antibodies. Confirmation of positive results by the screening tests was carried out by Western blot. The prevalence of HIV seropositivity was 4% (8 women). Specific treponemal antibodies were found in 50% (90/181) of the prostitutes as judged by Treponema pallidum haemagglutination assay (TPHA) and/or fluorescent treponemal antibody-absorption (FTA-ABSIgG) test. As estimated by the positivity of any or both non-treponemal tests (VDRL and RPR), a total of 31 (17%) out of the 181 women had active syphilis. A good correlation was found between the results obtained by TPHA and FTA-ABSIgG. IgM antibodies were found in 72% of sera positive by TPHA and/or FTA-ABSIgG. Four out of the 181 women were found to have antibodies to both HIV and Treponema pallidum.
A Study to Estimate the Prevalence of Upper Respiratory Tract Papillomatosis in Patients with Genital Warts
Authors: Clarke Janette , Terry R M , Lacey C J N
Published: January 2017

Respiratory tract papillomas are associated with human papillomavirus (HPV) types 6 and 11; these HPV types are also commonly associated with genital warts (condyloma acuminata). Although most commonly seen in young children, the incidence of respiratory tract papillomas in young adults is increasing. It has been postulated that orogenital contact is the means of transmission in this age group. We performed a survey of adults with genital warts to assess the prevalence of respiratory tract papillomatosis in relation to sexual behaviour and other factors.

Fifty-three adult patients (35 male, 18 female) with genital warts attending a genitourinary medicine clinic agreed to examination of the mouth and throat, including indirect laryngoscopy. Seventy per cent of the group had participated in oral sex. Two patients (3.8%) had lesions attributable to HPV infection of the oropharynx and larynx (one with laryngeal keratosis, one with papilloma of the pharynx). There was no specific risk factor identified to predict respiratory tract disease.

In view of the high infectivity of genital warts, it is interesting to note the low prevalence of oropharyngeal warts in adults indulging in orogenital contact. Since malignant transformation is known in respiratory tract papillomas, we would recommend that any patient with genital warts who develops unexplained hoarseness has a specialist examination of the upper respiratory tract.
Gonorrhoea: Signs, Symptoms and Serogroups
Authors: Horner P J , Coker R J , Turner A , Shafi M S , Murphy S M
Published: January 2017

Over 19 weeks, 104 male patients attending a genitourinary medicine clinic with gonococcal urethritis were asked to complete a questionnaire detailing symptoms. Sixty-seven questionnaires were duly completed. The examining nurse documented signs. Ninety-one isolates of Neisseria gonorrhoeae were serogrouped and auxotyped, 55 of these were from patients who had completed a questionnaire. Patients presented earlier if they had a past history of gonorrhoea ( p=0.02). The serogroup of N. gonorrhoeae did not influence the amount of discharge, the presence of meatal inflammation, dysuria or penile tip irritation or the delay in presentation after appearance of discharge. Auxotype AHU was not associated with asymptomatic gonorrhoea.
Sexual Behaviour Amongst Travellers: A Study of Genitourinary Medicine Clinic Attenders
Authors: Daniels David G , Kell Phillip , Nelson Mark R , Barton Simon E
Published: January 2017

Two hundred and fifty attendees at two London genitourinary medicine clinics were asked to complete an anonymous self-administered questionnaire, enquiring about sexual behaviour whilst abroad. Two hundred and forty-three questionnaires were evaluable. In the study group there were 116 women, and 127 men (62 heterosexuals and 65 homosexuals). Ninety women, 53 heterosexual men and 53 homosexual men had travelled abroad over the preceding 6 months. Of these 18 (20%) of women, 26 (51%) of heterosexual men and 19 (36%) of homosexual men had sex with a local foreign contact on holiday. Although both heterosexual and homosexual men were statistically more likely to have sex abroad with a local inhabitant, women were more likely to have unprotected sexual intercourse with a local partner. This has important implications for the spread of sexually transmitted disease including hepatitis B and HIV.
HIV at the Hospital/General Practice Interface: Bridging the Communication Divide
Authors: Guthrie Bruce , Barton Simon
Published: January 2017

Good communication between hospital HIV units and general practitioners is essential if people with HIV are to receive appropriate medical care in the community. However, in the UK the experience of general practitioners looking after people with HIV has been that communication is often inadequate. The reasons for this relate to the way that the HIV epidemic has evolved in the UK and the way that health services providing care in HIV have developed. In this review we will examine the causes of the present situation and suggest ways of improving communication which will have beneficial effects on the care of people with HIV.
Preventing Unprotected Anal Intercourse in Gay Men: A Comparison of Two Intervention Techniques
Authors: Gold Ron S , Rosenthal Doreen A
Published: January 2017

This study compared the effectiveness of getting gay men to evaluate the self-justifications they use when breaking their safe sex rules to that of a standard approach to AIDS education. Men ( n = 109) who had ‘slipped up’ (broken their safe sex rules by having unprotected anal intercourse) kept diaries of their sexual behaviour for 16 weeks. After 4 weeks they were allocated to one of 3 conditions, 2 involving brief interventions—Self-justifications (evaluation of self-justifications) and Standard (examination of posters used in AIDS education)—and a Control (diary only). At the time of the intervention, more members of the Self-justifications than the Standard group thought that it would help them not to slip up. In the post-intervention period, the 3 groups did not differ in the incidence of sexual activity or in the proportion who slipped up at least once, but the Self-justifications group were less likely to have had multiple slip-ups. Three possible explanations are offered for the effectiveness of the Self-justifications intervention. This approach may provide a useful alternative to standard techniques of AIDS education.
Temporal Changes in the Sensitivity of Neisseria Gonorrhoeae to Penicillin in Edinburgh, Scotland
Authors: Ross J D C , Moyes A , McMillan A , Young H
Published: January 2017

Increased resistance of Neisseria gonorrhoeae to penicillin has been reported from many centres around the world since the introduction of antibiotic therapy in the 1940s. This study reports the temporal changes in gonococcal penicillin sensitivity over a 3-year period. All patients with a diagnosis of gonorrhoea in the city of Edinburgh, Scotland between 1990 and 1992 were included in the study. Penicillin sensitivity of isolates was analysed in relation to the sex and sexual orientation of the patient and the antibiotic therapy given.

Four hundred and twenty-seven new patient episodes of infection occurred of which penicillin sensitivities were available in 426. Eleven episodes of PPNG infection occurred. Chromosomally mediated penicillin resistance did not increase over the study period. No differences were evident in the sensitivity of isolates from homosexual and heterosexual patients.

Unlike many other areas the relative resistance of N. gonorrhoeae is not increasing in Edinburgh at present. This may relate to local antibiotic policies combined with intrinsic characteristics of N. gonorrhoeae itself. Unlike previous reports there did not appear to be any increased resistance- to penicillin in isolates from gay men.
Sir James Mouat, VC KCB FRCS (1815–1899): Winner of the First Medical Victoria Cross
Authors: Lawrenson Ross
Published: January 2017

Sir James Mouat was the first of 36 doctors to win the Victoria Cross. Born in Kent in 1815, he was educated at University College London before joining the army. After service in India and Ireland he joined the 6th Dragoon Guards as regimental surgeon and served with them throughout the Crimean War. He won his VC at the Battle of Balaclava. After the Crimean War he was appointed principal medical officer to the British troops in the New Zealand Wars. After serving in New Zealand he returned to England and became Inspector General of Hospitals. Surgeon General Mouat retired on 28 April 1876. He was appointed an honorary surgeon to the Queen in 1888, and a Knight Commander of the Order of the Bath in 1894. He died of a stroke on 4 January 1899 at the age of 83.
Maternal Serum Screening in Ontario Using the Triple Marker Test
Authors: Summers A M , Farrell S A , Huang T , Meier C , Wyatt P R
Published: January 2017

Objectives:

To summarise the experience and evaluate the performance of the Ontario maternal serum screening (MSS) programme.

Methods:

This study used information collected in the Ontario MSS database, which contains data on each screened pregnancy. In the Ontario MSS programme, women are screened between 15 and 20 weeks of gestation. The risk cut-off for Down's syndrome was ≥1 in 385 at term and women with a serum alpha-fetoprotein ≥2.2 multiples of the unaffected population median were defined as screen-positive for open neural tube defects.

Results:

Between 1 October 1993 and 30 September 2000, 428,410 women residing in Ontario were screened for open neural tube defects, and 423,895 women were screened for Down's syndrome and trisomy 18. Approximately 48% of all pregnant women in the province had MSS. The uptake rate of amniocentesis following a positive Down's syndrome screening was 67%. Of 717 cases of Down's syndrome ascertained in the screened population, 531 were detected by MSS, giving a term detection rate (DR) of 70.6%, with a false-positive rate (FPR) of 7.2%. For neural tube defects, the DRwas 72.7%, with a FPR of 2.0%. The screen also detected 50% of cases of trisomy 18 at term, with a FPR of 0.2%. Coincidentally, 113 cases of chromosome aneuploidies other than Down's syndrome and trisomy 18 were detected

Discussion:

In the Ontario MSS programme, MSS performed as expected in the detection of Down's syndrome, open neural tube defects and trisomy 18. MSS is an effective and practical method for large- scale second ttrriimester screeni.ng for Down's syndrome, open neuraI tube defects and ttrriisomy 18, and the MSS database is an extremely useful tool in monitoring the performance of this screen.
A Rational Approach to Radiological Screening in Von Hippel-Lindau Disease
Authors: Harries R W J
Published: January 2017

Objectives—

To optimise radiological screening in von Hippel-Lindau disease (VHL) while minimising cost and morbidity.

Methods—

A model of VHL was based on retrospective studies, and Bayes's theorem used to calculate the probability of the gene's presence and the likelihood of further lesions in affected families. A six year follow up was conducted to test the validity of the model.

Results—

Follow up confirmed the accuracy and validity of the model. Posterior fossa haemangioblastomas occur in 79·2% of VHL cases, supratentorial, retinal and spinal haemangioblastomas in 6·9%, 42·8%, and 22·0%, phaeochromocytomas in 5·2%, and renal carcinomas in 14·5%. Population incidences are 1:15 700 live births (posterior fossa), 1:780 000 (supratentorial), and 1:116 000 (spinal). The birth rate of subjects with VHL is 1:43 000; new mutations occur in 1:178 000 live births. Penetrance is 90%; 40% present with multiple lesions and 6·4% die within two years after diagnosis.

Conclusions—

For most patients presenting with a VHL-type lesion, with sufficient clinical and pedigree data, the presence or absence of the VHL gene, and the probability of further lesions occurring, can be assessed with a high degree of accuracy using the method described in this paper. Those cases in the non-VHL group do not require long term radiological follow up, nor do their relatives require radiological screening. Subjects in the VHL group should be screened for renal carcinoma indefinitely from the age of 20 years, and all clinically unaffected relatives should be screened genetically for the VHL gene. (Those found negative for the gene do not require further screening, but those found positive should be screened.)
The Spectral Duration of Malayalam Soft-porn: Disappearance, Desire, and Haunting
Authors: Mini Darshana Sreedhar
Published: January 2017

This paper examines the spectral nature of the genre of Malayalam soft-porn that emerged in the late 1980s but has now disappeared with rapid changes in the industry. I argue that the memory of soft-porn bleeds into the present, as if in an attempt to negotiate retroactively with the end of the celluloid era and to recoup the memory of the form that has been pronounced dead and gone by the end of 2000s. By examining the modes through which cinematic memory carries the charge of the immanent past into the contemporary moment both in terms of narrative strategies and the physical space of the cinema, I look at S.P. Theater in Trivandrum, the film Kanyaka Talkies and the installation Kuliyum Mattu Scenukalum by Priyaranjan Lal, all of which reflect the form of soft-porn as remnants of the past that haunt the present in significant ways. S.P. Theater, located in the outskirts of the city of Trivandrum, insistently maintained its status as a popular destination for soft-porn aficionados even after the form had fizzled out in the industry. On the other hand, the film Kanyaka Talkies traces the life of a fictional soft-porn theater that was converted to a Church. One of the crucial moments in the film features the installations that would later become part of Lal’s Kuliyum Mattu Scenukalum to reflect the inner contradictions in the built space of the Church/Theater. Between the fictional rendering of the soft-porn theater in the film, and its “real” variant in the form of S.P. Theater, I argue that the current cinema-scape is marked by a lingering ghostly presence of a recently deceased film form.
Bazaars and Video Games in India
Authors: Deka Maitrayee
Published: January 2017

This article examines the history of video games in India through the lens of Delhi’s electronic bazaars. As many gamers shifted from playing Atari Games in the 1980s to PlayStation in the 2000s, we see a change in the role that the bazaars play. Throughout the 1980s and 1990s, the bazaars were the crucial channels of smuggling video games into India. In the 2000s, the bazaars face competition from official channels. Increasingly, the branded showrooms and online market attract elite consumers who can afford to buy the latest original video game. I argue that, while in the twenty-first century, the electronic bazaars have seen a decline in their former clientele, they now play a new role: they have become open places through the circulation of “obsolete” video games, and the presence of a certain bazaari disposition of the traders. The obsolete games in the form of cartridge, cracked console, and second hand games connect video games to people outside the elite network of corporate and professional new middle class. This alongside the practice of bargaining for settling price creates dense social relationships between a trader and a consumer.
Upholding Equality and Social Justice: A Social Constructivist Perspective on Emancipatory Career Guidance Practice
Authors: Bassot Barbara
Published: January 2017

After several years of political agendas focused on social inclusion, career guidance practice needs to return to its roots of promoting equality and social justice. This conceptual article argues that for many years there has been an overreliance on theories focused on the individual, and examines the relationship between social structures and individual agency. It presents insights from a social constructivist perspective, built on the application of collectivist interpretations of the zone of proximal development, situated learning and activity theory. Social constructivism asserts that individuals cannot be separated from their social context, and that social context is dynamic and constantly changing. The article concludes with the identification of the zone of proximal development as a useful overarching construct to support progress towards emancipatory career guidance practice.
The Black Dog Institute
Authors: Parker Gordon
Published: January 2017

Objectives:

To describe the structural and functional components of a new State-based initiative addressing depressive disorders, the Black Dog Institute.

Method:

Institute components and objectives, together with background information on the ‘Black Dog’ concept, are described.

Conclusions:

It is hoped that this briefing will inform readers about current objectives.
Seeking asylum
Authors: Velakoulis Dennis , Pantelis Chris
Published: January 2017

Objective:

To highlight our duty of care for patients with persistent and treatment-resistant chronic schizophrenia, some of whom remain homeless.

Conclusions:

That schizophrenia as an illness has not changed, nor has the efficacy of our treatments. A minority of patients have and will continue to develop persistent and chronic illness. Asylum can offer the time and structure required for the maximisation of function and symptom treatment.
An initiative in primary care psychiatry in South Australia
Authors: Paterson Tom , Seiboth Christopher , Magin Barbara , Nagesh Rajan , Lloyd Cyndy , Williams Helena
Published: January 2017

Objective:

To describe a joint mental health project involving the Adelaide Northern Division of General Practice (ANDGP) and the North West Adelaide Mental Health Service (NWAMHS).

Conclusions:

This project has been developed to explore alternative strategies to facilitate the identification and management of patients with mental illness in the primary care setting. The project has also endeavoured to explore alternative types of psychiatrist/general practitioner interactions other than the conventional ‘general practitioner referred psychiatrist consultation’. The development of adequate and clinically relevant evaluation methods, both quantitative and qualitative, has also been an explicit objective of the project. While the project provides an exciting stimulus for ongoing development of models of Primary Psychiatric Care, it is evident that such models can only evolve in the context of significant service and systemic change. It is hoped that the experiences in the northern suburbs of Adelaide can stimulate others to explore the ongoing collaborations between psychiatric services and general practitioners in ways that can produce better mental health outcomes in our patients.
Emergency Department Asthma Treatment Protocol
Authors: Joe Ronald H. , Kellermann Arthur , Arheart Kristopher , Ellis Robert , Self Timothy
Published: January 2017

OBJECTIVE:

The purpose of this study was to determine if a brief educational intervention (INT) on the treatment of acute asthma improved prescribing patterns of internal medicine residents in an emergency department (ED). Additional objectives were to determine if optimal therapy reduced length of stay (LOS) in the ED and to determine if discharge prescribing patterns could be improved.

DESIGN:

Nonrandomized, single-blind INT study.

SETTING:

A large, urban, county-owned, university-affiliated ED.

PATIENTS AND OTHER PARTICIPANTS:

Eight internal medicine residents in each of three study periods; numbers of adult asthmatics for each period were: control group, 129 (Nov—Dec 1989); INT group A, 82 (Jan—Feb 1990); and INT group B, 139 (Nov—Dec 1990).

INTERVENTIONS:

INT consisted of a ten-minute verbal presentation, a three-page summary of the literature, and a posted protocol in the ED. Control data were collected prior to any INT. Prescribing patterns were covertly evaluated in each of the three study periods. Because discharge prescribing of long-term antiinflammatory therapy with inhaled corticosteroids was not improved in group A, emphasis on this point was added for group B.

MAIN OUTCOME MEASURES:

Percentage of patients who received desired acute and discharge therapies and LOS for each study period.

RESULTS:

Increased prescribing of desired acute therapy in the ED was seen in both INT groups. For discharge prescribing, the INT was partially successful. Reduced LOS was not found for the INT groups.

CONCLUSIONS:

A brief INT effectively improves prescribing of optimal acute therapy of asthma in the ED, yet does not appear to reduce LOS. Further strategies are needed to impact on therapy prescribed at discharge from the ED.
Mitomycin-Induced Pulmonary Toxicity: Case Report and Review of the Literature
Authors: Linette Donna C. , McGee Karen H. , McFarland James A.
Published: January 2017

OBJECTIVE:

This report describes a case of mitomycin-induced pulmonary toxicity and reviews the incidence of this adverse effect, reported patterns of toxicity and associated dosages of the drug, and the use of corticosteroids in the management of pulmonary toxicity.

DATA SOURCES:

Information about our patient was obtained in part from the medical chart; we had also treated him personally in the past. We conducted a MEDLINE search of the English language literature (restricted to human studies) from 1966 to 1991 and manually searched Index Medicus for current information.

STUDY SELECTION:

All case reports that described pulmonary toxicity possibly associated with mitomycin were reviewed.

DATA EXTRACTION:

Studies were evaluated for the dosages of mitomycin given to patients, the nature and onset of symptoms, management course, and corticosteroid use.

DATA SYNTHESIS:

Our case is similar to others described in the literature. The incidence of mitomycin-induced pulmonary toxicity has been reported to range from 2 to 38 percent. Concurrent vinca alkaloid administration may potentiate the risk of an acute pulmonary insult secondary to mitomycin use. The toxicity is usually of slow onset and the average total dosage of drug implicated is 78 mg. A formal evaluation of corticosteroid treatment has not been performed, but various authors have reported success with different regimens.

CONCLUSIONS:

The incidence of pulmonary toxicity associated with mitomycin is unpredictable, but more likely to occur at higher dosages. Treatment with corticosteroids is encouraged to improve pulmonary response.
Inadequate Adrenergic Response to Disopyramide-Induced Hypoglycemia
Authors: Smith Richard C. , Sullivan Michael , Geller Jack
Published: January 2017

OBJECTIVE:

To report a case of disopyramide-induced hypoglycemia and to discuss the observed inadequate adrenergic response in this patient. Risk factors, possible etiologies, and preventive measures are also discussed.

DATA SOURCES:

References from case reports and review articles as identified by MEDLINE.

DATA SYNTHESIS:

A wide variety of drugs has been implicated as causing hypoglycemia. The mechanism for drug-induced hypoglycemia is known for the majority of these agents. Case reports of disopyramide-induced hypoglycemia have been reported in the literature, but the mechanism of action is unclear. We report a case of disopyramide-induced hypoglycemia in which counterregulatory hormones, serum insulin, and C-peptide concentrations were obtained. From these data, it appears that disopyramide-induced hypoglycemia results from endogenous insulin secretion, with concomitant inadequate counterregulatory response.

CONCLUSIONS:

Although a rare occurrence, disopyramide-induced hypoglycemia is potentially life-threatening. Patients at risk for this reaction need to be identified prior to the institution of disopyramide therapy. Patients at risk for hypoglycemia should be monitored while on disopyramide and disopyramide blood concentrations should be maintained at the lower end of the therapeutic range, or alternative agents should be considered.
Postmortem Changes and Pharmacokinetics: Review of the Literature and Case Report
Authors: Shepherd Michele F. , Lake Kathleen D. , Kamps Melissa A.
Published: January 2017

OBJECTIVE:

To review the mechanisms and sequence of events that occur during ischemia and cell death and following death of the human body. The impact of these postmortem events on the distribution and pharmacokinetic behavior of drugs is described. The case study presented illustrates a possible situation where such postmortem changes could have affected the pharmacokinetics of procainamide.

DATA SOURCES:

English-language journal articles and reference texts identified from pertinent data sources.

DATA SYNTHESIS:

Postmortem changes in the human body begin at the cellular level with the onset of ischemia. As the length of time of ischemia increases and death ensues, more changes occur and lead to deterioration in tissue and organ function. These changes may affect the pharmacokinetic and distribution behavior of certain drugs. Drugs particularly affected are those whose distribution is dependent on molecular size, lipophilicity, pH, energy-dependent transport, and tissue binding. Such drugs include the tricyclic antidepressants, digoxin, and cimetidine. Other drugs with similar characteristics, such as procainamide, may also demonstrate like changes in distribution and pharmacokinetics.

CONCLUSIONS:

When measuring drug concentrations after death, it is important to consider the phenomenon of postmortem redistribution. Postmortem drug concentrations may not be a true reflection of antemortem concentrations and as a result, wrong conclusions could be made about the cause of death. More studies characterizing the postmortem distribution and pharmacokinetic characteristics of specific drugs are necessary.
Taurine: An Essential Amino Acid to Prevent Cholestasis in Neonates?
Authors: Howard Denise , Thompson Dennis F.
Published: January 2017

OBJECTIVE:

To review the evidence that taurine can prevent cholestasis in neonates.

DATA SOURCES:

MEDLINE and EMBASE searches were conducted to identify both animal and human data regarding taurine's role in bile acid conjugation and liver disease (key terms: taurine, children less than two years old).

STUDY SELECTION:

Emphasis was placed on human data supplemented by relevant animal data.

DATA SYNTHESIS:

Taurine appears to more effectively conjugate bile acids than glycine, and the end-products of conjugation are more soluble. Taurine deficiency may increase glyco-conjugates of bile acids and result in cholestasis. Although the cause of neonatal cholestasis probably is multifactorial, there are data indicating that adequate taurine may prevent cholestasis in neonates.

CONCLUSIONS:

Taurine should be considered an essential amino acid for neonates and should be included in total parenteral nutrition solutions for these patients.
Transdermal Fentanyl
Authors: Yee Lisa Y. , Lopez Julio R.
Published: January 2017

OBJECTIVE:

To review the use of transdermal fentanyl for the treatment of moderate to severe chronic pain. The article provides background on the pharmacology and pharmacokinetics of the drug, as well as the properties of the transdermal system. In addition, clinical trials, adverse effects, and therapeutic considerations and recommendations are presented.

DATA SOURCES:

Clinical trials, review articles, and reference texts.

STUDY SELECTION:

Comparative clinical trials involving the use of transdermal fentanyl on postoperative and chronic pain patients.

DATA EXTRACTION:

Data from clinical human trials published in the English language were reviewed. Trials were assessed by sample size, opioid dosage regimen, and therapeutic outcome.

DATA SYNTHESIS:

Transdermal fentanyl was found to be effective in the control of chronic and postoperative pain. In one trial the overall patient satisfaction with pain control was 79 percent for the transdermal fentanyl group and 44 percent for the placebo group. In another trial, the amount of additional parenteral morphine was significantly lower for the group receiving transdermal fentanyl than for the placebo group (49.9 ± 4.9 vs. 77.0 ± 6.3 mg, respectively, p<0.01). The most common adverse effects recorded were nausea (45–85 percent), pruritus (14–60 percent), and sedation (40–59 percent). The cost of analgesic therapy with this delivery system is higher than that of parenteral opioid analgesia, but less than patient-controlled analgesia.

CONCLUSIONS:

The transdermal fentanyl formulation offers some minor advantages over other forms of conventional pain management. Results of early clinical trials are promising, but more studies are needed to evaluate its long-term effectiveness and adverse effects. Specifically, comparisons with standard parenteral and patient-controlled opioid analgesia in chronic malignant and nonmalignant pain are necessary for adequate evaluation of transdermal fentanyl.
Intravenous-to-Oral Stepdown Program: Four Years of Experience in a Large Teaching Hospital
Authors: Frighetto Luciana , Nickoloff Donna , Martinusen Shelagh M. , Mamdani Fatima S. , Jewesson Peter J.
Published: January 2017

OBJECTIVE:

To assess the impact of an intravenous-to-oral (iv-po) stepdown program on the relative use of oral and parenteral dosage forms of select antimicrobials.

DESIGN:

A retrospective review of drug utilization records before and after a trial comparing metronidazole and clindamycin prescribing trends from a 12-month baseline period to a four-year follow-up period.

SETTING:

One thousand-bed Canadian tertiary care referral teaching center.

INTERVENTION:

An authorized iv-po stepdown program was developed to promote the oral route of drug administration. Reminders of iv-po stepdown were produced for metronidazole and clindamycin and these notes were sent to nursing units with the parenteral dosage form. The notes then were attached to the front of the health record to serve as a reminder to prescribers that an equally effective, well-tolerated, and less-expensive oral dosage form was available for use.

RESULTS:

A 44 percent relative increase in the use of oral metronidazole and a 79 percent relative increase in the use of oral clindamycin occurred. When acquisition and delivery costs were considered, cumulative cost savings from 1988 to 1991 resulted for metronidazole ($31920) and clindamycin ($53880).

CONCLUSIONS:

This intervention represents a simple yet effective method of promoting a process of stepdown from parenteral to oral antibiotic therapy.
Aspirin for the Prevention of Vascular Death in Women
Authors: McAnally Laura Engles , Corn Carolyn R. , Hamilton Stephen F.
Published: January 2017

OBJECTIVE:

To review current information relevant to the use of aspirin for preventing vascular death in women, and to provide recommendations based on this information.

DATA SOURCES:

References from pertinent articles are identified throughout the text.

DATA SYNTHESIS:

Based on current information, low-dose aspirin is not recommended as primary prevention for cardiovascular death in women; efforts are better focused at promoting risk-factor reduction. Low-dose aspirin is recommended for reducing further cardiovascular morbidity and mortality in women with known cardiovascular disease. Women presenting with unstable angina or myocardial infarction should receive aspirin 325 mg as soon as the diagnosis is confirmed, and this dosage should be continued on a chronic basis. Women who have experienced transient ischemic attacks or ischemic stroke should receive aspirin 1000 mg/d, with a subsequent dosage reduction to 325 mg/d in patients who do not tolerate the higher dose.

CONCLUSIONS:

Current recommendations are based on the results of studies that involved few women. Further investigation of antiplatelet agents for primary and secondary prevention of vascular death in women is needed.
Use of Fish Oil to Prevent Coronary Angioplasty Restenosis
Authors: Mauro Vincent F. , Frazee Lawrence A.
Published: January 2017

OBJECTIVE:

To review the literature investigating the use of fish oil in preventing restenosis postangioplasty (RPA).

DATA SOURCES:

An Index Medicus and bibliographic search of the English-language literature pertaining to the use of fish oil in preventing RPA. The key terms used were fish oil, angioplasty, and eicosapentaenoic acid.

STUDY SELECTION AND DATA EXTRACTION:

The results of all trials, including abstracts, that were obtained are reviewed and critiqued.

DATA SYNTHESIS:

Restenosis of a coronary vessel at the site of angioplasty occurs 30–40 percent of the time. Because fish oil has been theorized to prevent atherosclerosis and because atherosclerotic-like processes are theorized to be involved in RPA restenosis, fish oil has been studied to determine whether it can prevent RPA. Results of such trials have been mixed. Some have observed a reduction in the number of patients with angiographic or clinical evidence of restenosis. Two trials have failed to observe such an effect. Reasons for the differences are unknown. Possible explanations include differences in study design, endpoint parameters, definition of restenosis, and dosing methods of the fish oil. Bleeding was not of significant concern in any of the trials, even when fish oil was combined with antiplatelet therapy.

CONCLUSIONS:

Fish oil may be considered for use in patients to prevent RPA. It probably should be continued for only six months following the procedure. Current data suggest that at least 3 g/d of eicosapentaenoic acid and 1 g/d of docosahexaenoic acid should be used. If possible, therapy should be started as soon as it is known that angioplasty will be performed or at least as soon as possible following the procedure. Many patients may not be able to tolerate fish oil because of its gastrointestinal effects.
Impact of Drug Use Evaluation upon Ambulatory Pharmacy Practice
Authors: Armstrong Edward P. , Terry Allan K.
Published: January 2017

OBJECTIVE:

To review the expansion of ambulatory drug use evaluation (DUE). A description of ambulatory DUE characteristics and methodology is included. In addition, DUE computer usage, documentation concerns, and future research issues are addressed.

DATA SOURCES:

A MEDLINE search was used to identify pertinent literature, including reviews.

STUDY SELECTION:

Primary and secondary literature describing ambulatory DUE was selected. Articles describing inpatient DUE were excluded.

DATA EXTRACTION:

Rigorous studies evaluating current ambulatory DUE programs are limited, but the available literature and a description of existing program characteristics are included. All studies available at the time of publication were reviewed.

DATA SYNTHESIS:

Ambulatory DUE can provide useful information to assist in providing pharmaceutical care. The Omnibus Budget Reconciliation Act of 1990 has prompted an expansion of DUE programs, and most of the formalized programs are retrospective in design. Prospective programs provide online, patient-specific drug use assessment whenever new prescriptions are entered into point-of-service databases.

CONCLUSIONS:

Although more well-designed evaluations of existing ambulatory DUE programs are needed, initial results indicate these programs may be extremely useful in identifying significant medication therapy problems and improving patients' drug therapy.
Costs of Pharmaceutical Care: Can the Profession do Anything?
Authors: Hopefl Alan W.
Published: January 2017

OBJECTIVE:

To review some of the factors that influence the cost of pharmaceuticals and the delivery of pharmaceutical care as well as some possible measures for decreasing these costs.

DATA SYNTHESIS:

Clinical studies have been selected to illustrate factors that may add to the overall cost of pharmaceutical care.

CONCLUSIONS:

Because of the perceived problems resulting from the introduction of new, expensive pharmaceuticals, possible means of controlling the costs of individual products are discussed. In addition, recommendations for achieving cooperation between pharmaceutical manufacturers and pharmacy practitioners in demonstrating the cost-effectiveness of new products are provided.