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Biomedical subjects

A H Mutnick

Publications and source records attributed to A H Mutnick.

30 records · Page 2Linked to original sources
PubMed1990

Cimetidine-associated adverse reaction.

Cimetidine, a histamine2-receptor antagonist, is used in the treatment and prophylaxis of peptic ulcer disease. Its use is relatively free of serious adverse reactions and only a few accounts of hypersensitivity exist. We report a case of intravenous cimetidine-associated adverse reaction characterized by junctional rhythm, bradycardia, and hypotension apparently not secondary to rapid intravenous cimetidine infusion. The adverse reaction was reproduced upon rechallenge. No previous accounts of this reaction appear clearly defined in the literature nor have such reactions been confirmed by rechallenge.

Aged↗
PubMed1990

Workplace redesign: meeting the challenge of change while living within your resources.

It is 9 months after reconfiguration, and it is safe to say that the operation is a success. The quality of distributive service provided by the department has improved. Pharmacists and technicians report a higher degree of job satisfaction, and the dimension and quality of the clinical programs now cannot be compared with before. Future plans are to evaluate technician order entry as a means of further increasing pharmacists' time for clinical activities. This must be accomplished in a manner that ensures appropriate concurrent monitoring and screening of orders with compromising patient therapy. The department also is planning follow-up surveys that address the staff's attitudes regarding the reconfiguration. Recognizing change as a dynamic process, we plan to continue involving the entire pharmacy staff in the planning and implementation of future change. While we as managers were able to recognize the need for global change, it is our staff who helped us identify specific changes that led us to the needed skill mix adjustment. It is also essential that the staff understand that resources are limited and that is why compromise is sometimes necessary.

Hospital Bed Capacity, 500 and over↗
PubMed1990

Dopamine versus dobutamine: are all the facts there?

During the last 5 years we believe that the prescribing of dobutamine has increased over that of the older agent dopamine. The literature reports advantages such as less tachycardia, less peripheral vasoconstriction, and fewer increases in intracardiac pressures with dobutamine as opposed to dopamine. After a thorough review of the literature, we were unable to find conclusive evidence of these initial findings, and present several studies to show potential flaws in their interpretation that may help explain the increased use of dobutamine over dopamine. The overuse of dobutamine, if it does exist, must be dealt with by pharmacy departments in an informed, yet unbiased fashion, to aid in preventing the continued escalation of health care costs.

Blood Pressure↗
PubMed1989

Clinical pharmacy education in new England: a report of the Whispering Pines Conference.

Clinical pharmacy practice as it relates to the future of the pharmacy profession has been examined at Hilton Head in 1985 and at regional conferences throughout the U.S. between 1986 and 1988. However, clinical pharmacy education and its role in the future of the profession had not been the focus of this type of "futuristic" conference. In 1988, the clinical pharmacy faculties from the four colleges of pharmacy in New England met to discuss the "Directions for Clinical Pharmacy Education in New England." Through a series of workshops, and stimulated by challenges from keynote speakers, the participants focused on the current status of clinical pharmacy education in New England, the barriers to change, and the strategies required to accomplish these changes. Consensus on prioritization of changes and their strategies was reached, and those that could be implemented in the near future were identified. Since the conference, changes have occurred and the professional networking that began at the conference has continued. This paper is a summary of the proceedings of this conference.

Curriculum↗
PubMed1988

Nicotinic acid: a review of its clinical use in the treatment of lipid disorders.

Nicotinic acid (niacin) is a water-soluble vitamin widely used for the treatment of lipid disorders. In pharmacologic doses (1 g or more/day), alone or in combination with other lipid-lowering drugs, nicotinic acid lowers very low-density (VLDL) and low-density lipoprotein (LDL) levels, while concurrently increasing high-density lipoprotein (HDL) levels. It may reduce long-term mortality in patients with known coronary artery disease and may slow or reverse the progression of atherosclerosis. A major consideration against using nicotinic acid is the occurrence of frequent, bothersome, adverse reactions such as cutaneous flushing, skin rash, and gastric upset. Careful dosing titration may, however, minimize these effects. The beneficial effects, taken together with the low cost of nicotinic acid therapy and the relative freedom from serious side effects, have made nicotinic acid the agent of choice for the treatment of many patients with hyperlipidemia.

Humans↗
PubMed1988

Dobutamine: a drug utilization evaluation.

During a recent fiscal year, a 243% increase in dobutamine costs--which were associated with increased drug use--was observed at Brigham and Women's Hospital in Boston. As a result of this increase, a drug usage evaluation was concluded to determine: the indications for which dobutamine was being prescribed, whether or not dopamine could be used in place of dobutamine, and any anticipated cost savings realized by targeting dobutamine prescribing. Forty-six consecutive patients who were receiving dobutamine for hypotension, congestive heart failure, or decreased urine output were evaluated during a 3-month study period. The results indicated that dopamine could have been used as initial therapy in the majority of patients. In only 3 patients was dobutamine considered the drug of choice. Furthermore, the institution could have reduced drug costs by more than $50,000 if the use of dobutamine could have been reserved for its most appropriate indications.

Boston↗
PubMed1981

Case study: complications associated with anticoagulant therapy.

A 42 year old male with gram negative pneumonia complicated by deep venous thrombosis was followed throughout his hospital stay and for two weeks following discharge. The treatment course is divided into five treatment periods, each with accompanying commentary. Drug interactions and neutralizations as well as dietary factors contributed to a complicated course. Laboratory determinations were used to directly evaluate therapeutic anticoagulant effects, and dosage regimens were adjusted to achieve desired anticoagulant levels.

Adult↗
PubMedDate not supplied

A cost analysis comparing erythropoietin and red cell transfusions in the treatment of anemia of prematurity.

BACKGROUND: Anemia of prematurity is invariably observed in very low birth weight infants and may become symptomatic enough to be treated with packed red cell transfusions. Recently, treatment of this condition with recombinant human erythropoietin has been advocated. STUDY DESIGN AND METHODS: To compare the costs of training symptomatic anemia in hospitalized premature infants with transfusions alone or with erythropoietin plus red cell transfusions as needed, cost estimates were derived from local hospital and published cost data. Decision analysis and sensitivity analysis were applied to a "base case." The base case was derived from results of a multicenter erythropoietin trial in the United States in which premature infants received 500 U of erythropoietin per kg of body weight each week. Because erythropoietin treatment began on average at 3 weeks of life, when infants were clinically stable, they had already received 3.5 red cell transfusions. During the 6-week treatment period, erythropoietin-treated infants received significantly fewer additional transfusions: a mean of 1.6 versus 1.1. RESULTS: The base-case cost in 1993 dollars for treating anemia in hospitalized premature infants with erythropoietin and transfusions was $1,326. This was nearly twice the cost of conventional treatment with transfusions alone ($721). If the 6-week treatment period alone is considered, erythropoietin is 3.6 times more costly: $840 versus $235. CONCLUSION: The largest available US study using erythropoietin to treat anemia in premature infants has demonstrated a small, but significant, reduction in transfusion needs. However, this study's cost data alone do not justify the widespread use of erythropoietin in premature infants. When this issue is probed in great depth, sensitivity analyses demonstrate that major reductions in erythropoietin's cost and/or improvements in its effectiveness quite possibly will make its use economically more attractive.

Anemia, Neonatal↗
PubMedDate not supplied

Application of decision analysis in antibiotic formulary choices.

OBJECTIVE: To introduce the reader to the fundamentals involved in using decision analysis as a tool in evaluating the associated costs and effectiveness of comparable therapeutic agents. DATA SOURCES: Currently available literature citations were used to provide the reader with basic references whose purpose is to provide a step-by-step approach for using Decision Analysis in conducting a cost-effective comparison of three commonly used antibiotics. Data were gathered from a previously conducted retrospective chart review where the three antibiotics were used for either prophylactic, empiric, or documented infections. Although this study was limited by its retrospective nature, the reader can use the data to appreciate the fundamentals of decision analysis. CONCLUSIONS: The continually changing climate in healthcare and the added visibility of pharmacologic agents in the treatment and prevention of disease has increased pressure on pharmacy departments to provide therapeutic agents that are cost-effective. Decision analysis can be used to compare therapeutic agents, in terms of financial as well as clinical outcomes, in a structured fashion that all members of the health care team can understand. The application of Decision analysis is appropriate for many therapeutic agents, not just antibiotics.

Anti-Bacterial Agents↗