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Biomedical subjects

A W Roberts

Publications and source records attributed to A W Roberts.

At least 55 records · Page 3Linked to original sources
PubMed1992

Evolving to provide pharmaceutical care without additional resources in a university hospital.

Our department is committed to a process of continuous quality improvement focusing on delivering the best possible pharmaceutical care services. Three committees, each with representation from pharmacists and pharmacy technicians from all areas of the department, were convened in 1991 to 1992 to further identify areas for service enhancement and to plan for the future. Based on the recommendations of these committees, further expansion in ambulatory services is a priority. Other changes will include further automation of the drug-distribution system, examination of the role of the pharmacy technician, development of an automated patient-care system with direct physician order entry, computerized documentation of clinical interventions, and reaffirmation of the role of the pharmacist as the professional responsible for proper use of medications at UMHC.

Centralized Hospital Services↗
PubMed1991

Hemolytic uremic syndrome/thrombotic thrombocytopenic purpura: outcome with plasma exchange.

A retrospective analysis was made of 14 consecutive adults with hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP) who were treated with plasma exchange (PE). In six patients the disease was primary, whilst in eight HUS/TTP was considered secondary to an associated condition. Thirteen patients had renal involvement, six had central nervous system symptoms or signs, three had fever, and one had myocardial damage. Twelve patients (86%) recovered. Four of these relapsed, but responded to further treatment. Two patients failed to respond and died. Hematological response occurred rapidly in survivors: thrombocytopenia resolved after a median of four exchanges, and hemolysis after a median of six. Four patients had a complete recovery, seven had residual mild end organ damage, and one had severe renal impairment. PE was an effective treatment for both primary and secondary HUS/TTP. The platelet count proved to be the earliest indicator of clinical outcome. Continuing follow-up of survivors is required because of the risk of relapse and the high incidence of end organ damage.

Adolescent↗
PubMed1990

Attempted transmission of Ehrlichia risticii (Rickettsiaceae) with Stomoxys calcitrans (Diptera: Muscidae).

Experimental transmission of Ehrlichia risticii, the causal agent of Potomac horse fever, was attempted with adult stable flies, Stomoxys calcitrans, (L.) using two feeding schedules. In schedule A, a set of 140 flies was allowed to feed once on an experimentally infected donor pony and once 24 h later on a recipient pony. A different set of flies was used each day for a 12-d period. In schedule B, 240 flies were allowed to feed once daily for 12 consecutive d on the donor pony followed by five consecutive daily feedings on the recipient pony. E. risticii was isolated from the blood of the experimentally infected pony during the entire fly-feeding schedule. The recipient pony did not develop clinical signs of Potomac horse fever and remained seronegative to E. risticii up to 60 d after the last stable fly feeding. Mice injected intraperitoneally with emulsions of schedule A and B stable flies were seronegative for E. risticii 30 d after inoculation, and ehrlichial organisms were not demonstrated in impression smears from the digestive tracts of the flies. The stable fly did not transmit E. risticii under these experimental conditions.

Animals↗
PubMed1987

Status of equine viral arteritis in Kentucky, 1985.

Clinical cases of equine arteritis virus infection have not been diagnosed in Kentucky since 1984, and there has been no indication that any of the horses involved in the 1984 epizootic have since been responsible for spread of the disease to horses in other states or other countries. Cases of abortion caused by naturally acquired infection with this virus have not been confirmed in 1984 or 1985. Neither field nor vaccine strains of equine arteritis virus have been shown to induce teratologic abnormalities or the carrier state in foals born to infected or vaccinated mares. The carrier stallion appears to have played a major epidemiologic role in the dissemination and perpetuation of the virus. A commercial modified live equine viral arteritis vaccine was found to be safe and efficacious for stallions and mares. The disease can be controlled by immunizing the stallion population and by restricting the breeding of equine arteritis virus-shedding stallions to vaccinated or seropositive mares, followed by an appropriate period of isolation from other nonvaccinated Equidae.

Animals↗
PubMed1987

The carrier state in equine arteritis virus infection in the stallion with specific emphasis on the venereal mode of virus transmission.

The carrier state has been confirmed virologically in Thoroughbred and non-Thoroughbred stallions naturally infected with equine arteritis virus (EAV). Short-term or convalescent and long-term carriers occur. The frequency rate of the long-term carrier state in Thoroughbreds was high, averaging 33.9% among the three groups of stallions under study. While the convalescent carrier state only lasted a few weeks after clinical recovery, the long-term carrier state could persist for years. There was evidence, however, that not all such carriers might remain persistently infected for life. Carrier stallions appeared to shed EAV constantly in the semen but not in the respiratory secretions or urine. It also could not be demonstrated in the buffy coat of the blood. All of the carrier stallions have continued to maintain moderate to high neutralizing antibody titres to EAV in serum. Virus was associated with the sperm-rich and not the pre-sperm fraction of semen. There was relatively little variation in virus concentration between sequential ejaculates from the same stallion. Transmission of EAV infection by long-term carrier stallions would appear to occur solely by the venereal route. Such carriers are thought to play an important epidemiological role in the dissemination and perpetuation of the virus.

Animals↗
PubMed1986

Demonstration of the carrier state in naturally acquired equine arteritis virus infection in the stallion.

The chronic carrier state was virologically confirmed in 15 thoroughbred stallions naturally infected with equine arteritis virus based on the results of test matings and, or, isolations of the virus from semen. Carrier stallions were shown to shed equine arteritis virus in the semen for at least one to two years. Existence of a short-term or convalescent carrier state was also demonstrated in five additional stallions. The frequency of the long-term carrier state in stallions naturally infected with equine arteritis virus was 35 per cent; it varied considerably between groups of stallions on different farms. The carrier stallion would appear to play an important epidemiological role in the dissemination and perpetuation of equine arteritis virus.

Animals↗
PubMed1985

Invasive carcinoma of the cervix in young women.

The cases of 194 women aged 40 years of age or less who had been diagnosed as having invasive cervical cancer in Queensland during 1972-1981 were reviewed retrospectively. Medical records contained a previous cervical cytological report for 89 women, with 18 of these having had a negative result of a smear test within two years of the diagnosis of invasive cancer. Cytological review of five of the 18 cases revealed neoplastic cells in three cases, and possible sampling inadequacies in the other two. Gynaecological symptoms had been present in seven of the 18 patients at the time of the negative result of cytological examination, and these persisted until the diagnosis was eventually made. A high index of suspicion is required when symptoms persist in spite of negative results of cytological examination and we recommend a review of the smear, a repeat smear examination with adequate sampling and referral for colposcopic examination in these circumstances.

Adult↗
PubMed1983

Effect on drug costs of implementing decentralized drug distribution.

The drug costs associated with a centralized drug-distribution system were compared with those of a newly implemented decentralized unit dose and i.v. admixture system in a university teaching hospital. Three months before and three months after implementation and stabilization of the new drug-distribution system, the mean drug cost per patient day was determined for each of 22 nursing stations. Variations in drug use were monitored to eliminate the influence of patient mix or treatment protocol. Data from 2 of the 22 nursing stations were excluded from analysis because of large variations in drug use. Twelve nursing stations demonstrated lower drug costs per patient day with the new drug-distribution system. Overall, an 18% reduction in drug costs per patient day was achieved. In this hospital, a decentralized drug-distribution system was associated with lower drug costs than the traditional distribution system.

Costs and Cost Analysis↗
PubMed1982

Design of a revised controlled substances distribution system.

A controlled substances distribution system that uses daily audit and disposition forms for three different groups of drug products is described. In the previously used system, only Schedule II drugs were controlled, using shingled proof-of-use forms for each product. All other controlled substances were dispensed like regular prescriptions. Accountability, record retrieval, and security weaknesses led to the development of a new system. The new system has a separate audit and disposition form for Schedule II injections, Schedule II orals and miscellaneous drugs, and Schedule III and IV oral and injectable drug products. Each form lists the most frequently prescribed products in the category. Nurses record daily shift counts on the bottom of the form. Twenty-one shingles are attached to the form that are similar to the shingles on the proof-of-use forms of the old system; these serve as patient charge slips. Each nursing station uses at least one of each form every day. Pharmacy reviews these forms daily for discrepancies and to determine the restocking needs of the nursing stations. A quality assurance program to assess the performance of the new system is described. Use of the daily audit and disposition forms for controlled substances combines accountability, security, and efficiency for nursing personnel with an effective charging mechanism.

Medication Systems, Hospital↗
PubMed1981

Why is there resistance to change and how can it be minimized?

The ability to implement change, as an administrative skill, is essential in effectively promoting progressive pharmacy practice. Often, pharmacy managers want to implement change but do not know how to approach the process without encountering much resistance from the staff. There are various sources of resistance that need to be recognized, including lack of trust, inaccurate or incomplete information, and potential loss. A pharmacy manager can take different approaches to minimize this resistance, depending on the organization and his or her management style. A pharmacy manager can use the techniques cited to turn the uncertainties of change into established gains and employee commitment.

Humans↗
PubMed1978

Comprehensive self-medication program for epileptic patients.

The establishment and operation of a comprehensive self-medication program for hospitalized epileptic patients are described. The patients in the program are required to meet established behavioral criteria during each of four stages of self-medication before progressing to the next stage. The patient has increasing responsibility in each successive phase of the program. The areas of patient involvement for the pharmacist are: (1) obtaining a medication history, (2) teaching patients about seizure medications, (3) conducting patient consultations during the self-medication program and (4) counseling the patient at discharge.

Counseling↗