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Biomedical subjects

C D Peterson

Publications and source records attributed to C D Peterson.

15 recordsLinked to original sources
PubMed1992

The derivation of gender-role scales GM and GF for MMPI-2 and their relationship to Scale 5 (Mf).

Separate scales for masculine and feminine gender roles (GM and GF, respectively) were developed for the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) based on the item endorsements of men and women in the restandardization sample. Each scale reflects the pattern of answers of a majority of the members of the respective sexes. There are no items in common between the two scales, and they correlate -.10 with each other for both men and women. Distributional, temporal stability, and internal consistency characteristics were analyzed, as well as their item overlap and correlations with the basic profile scales. These separate unipolar scales were contrasted with Scale 5 (the Masculinity-Femininity scale, Mf), the traditional measure of these constructs in the Minnesota Multiphasic Personality Inventory (MMPI). The conjoint use of GM and GF to form gender-role groups is recommended to supplement and clarify the ambiguity of midlevel scores on Scale 5.

Adult↗
PubMed1991

Computer-based program for identifying medication orders requiring dosage modification based on renal function.

A computer-based program that enables staff pharmacists to quickly review medication orders written for renally impaired patients is described. Medication orders requiring dosage modification based on the renal function of the patients for whom they were written were being identified by a medical staff-approved pharmacist intervention program. However, staff pharmacists were unable to assess the orders easily and rapidly because of a lack of readily available patient data. In response, a computer-based intervention program was developed. Specific dosage guidelines for renally eliminated drugs in patients with renal dysfunction were entered into the pharmacy computer. An interface with the laboratory computer enables the pharmacy computer to access creatinine concentration or clearance values, perform calculations if necessary, and alert pharmacists to specific drug orders that may require modification. Such medication orders are flagged by the pharmacy computer during order entry. When a staff pharmacist judges that intervention is needed, he or she telephones the ordering physician or sends a note to the patient's nursing station. Over a two-month period, 1485 orders were identified as being potentially inappropriate. Physicians were contacted about 191 of the flagged orders, and they accepted the pharmacist's recommendation for 141 (74%) of these orders. The interventions resulted in a drug acquisition cost saving of $7082 over the two-month period. A computer-based program enabled staff pharmacists to easily and rapidly identify orders for renally eliminated agents that required modification, reduced the risk of adverse reactions, trimmed costs, and promoted the clinical dimension of pharmacy practice.

Clinical Pharmacy Information Systems↗
PubMed1990

Quality improvement in pharmacy: a prescription for change.

Quality improvement activities offer pharmacists opportunities for establishing their roles as clinical practitioners, documenting their contributions to quality-of-care improvement, and bringing recognition to pharmacy as a clinical profession. Unfortunately, pharmacists haven't yet recognized the importance of or need for these programs. Drug usage evaluations and quality improvement still are not considered a benefit or an opportunity but continue to be perceived as boring, tedious tasks that must be performed for the Joint Commission rather than the patient. The time has come to refocus our emphasis on what really matters. We need to build quality improvement programs not merely to placate the Joint Commission but to improve the quality of care for patients. We need to build quality improvement programs that extend to the grass roots level of every organization so that everyone is involved, participating, and committed to correcting patient-care problems. This commitment must become a routine habit, a daily acknowledgment, and an ongoing process. Clinical practitioners must become actively involved in quality improvement programs by developing valid, reliable indicators to help ensure safe, appropriate use of drugs. We need to develop a computer model to assist in data collection for drug usage evaluations and quality improvement projects. And we must create a multidisciplinary team of practitioners, including physicians, nurses, and pharmacists, to thoroughly evaluate and respond to this information. A successful team effort means everybody wins, and the biggest winner of all is--and must be--the patient.

Joint Commission on Accreditation of Healthcare Or↗
PubMed1990

The Beck Depression Inventory: item order and the impact of response sets.

The lack of subtle content in the item groups of the Beck Depression Inventory (BDI) and the consistency in the ordering of the items from least to most pathological make this instrument unduly susceptible to either defensive or malingering response sets. Two experimental forms were developed for the BDI: a backwards version (a simple reversal of the order of items within each group) and a random-order version. These forms, together with the original item order, were given to college undergraduate women along with the Depression scale from the MMPI and the Burks-Martin Questionnaire covering recent life changes and current stressful situations. The random order BDI results in a significantly higher depression score than did either the original or backwards version. Correlations with the other instruments were comparable for all three forms. The random order of items within each set appears to break up a response set to endorse either the first or last item and is, therefore, recommended.

Adjustment Disorders↗
PubMed1989

Pharmacy-coordinated process for evaluating physician drug prescribing.

A pharmacy-coordinated process is described in which the frequency and types of inappropriate drug prescribing are evaluated as part of the medical staff quality assurance and physician credentialing program. A pharmacist intervention program was implemented at an 838-bed private hospital to review all medication orders for appropriateness and to intervene with physicians and nurses when problems in drug prescribing or administration were identified. During a five-year period there were more than 6500 drug therapy interventions. Because of the recurrent problems identified, the medical staff asked the pharmacy department to develop a process for objectively evaluating the quality of prescribing practices that could be used in the medical staff quality assurance program and in physician credentialing. The drug-prescribing activities of physicians applying for clinical privileges are subjected to a "macro" review by using a computerized clinical financial information system to extract drug-use information from patients' bills. In a "micro" review, patient records are retrospectively analyzed by Pharm.D. clinical specialists; all medications prescribed by the physician for those patients being evaluated are scrutinized. Appropriate response scores are calculated by dividing the number of appropriate responses by the total responses. The pharmacy department in this hospital has assumed a more active role in patient care through its participation in a process for objectively evaluating the quality of prescribing practices.

Diagnosis-Related Groups↗
PubMed1988

Evaluation of a method for initiating vancomycin therapy: experience in 205 patients.

This study evaluated a dosing method for initiating vancomycin therapy in a large population based on patients' age, weight, and renal function. The aims were to determine the method's efficacy in achieving predetermined peak and trough serum concentrations, and to calculate the cost savings incurred by individualizing therapy. Average doses +/- 1 SD of 7.93 +/- 0.29 mg/kg corrected body weight (lean body weight + 40% excess weight) were administered at intervals predicted by the patients' estimated creatinine clearances (range 22-130 ml/min). The calculated mean dose +/- SD was 558 +/- 83 mg (range 350-750 mg) and the calculated median interval was 12 hours (range 6-24 hr). Peak and trough concentrations +/- SD measured at steady state averaged 26.0 +/- 5.4 and 7.3 +/- 2.3 micrograms/ml, respectively. Peak and trough serum concentrations fell within the predetermined therapeutic range in 311 (76%) of 410 samples. Peak concentrations were in the range of 20-30 micrograms/ml in 145 (71%) of 205 samples. Trough concentrations were in the range of 5-10 micrograms/ml in 166 (81%) of the 205 samples. This simplified dosing method successfully individualized therapy in most patients, and produced a significant savings to the pharmacy in reduced drug acquisition costs and to patients in reduced drug charges.

Adult↗
PubMed1988

Component wear of total knee prostheses using Ti-6A1-4V, titanium nitride coated Ti-6A1-4V, and cobalt-chromium-molybdenum femoral components.

A knee simulator was used to study the wear of carbon fiber reinforced UHMWPE (Poly Two) (Poly Two is a registered trademark of Zimmer, USA) tibial and patellar components against Ti-6A1-4V, titanium nitride (TiN)-coated Ti-6A1-4V, and cobalt-chromium-molybdenum femoral components. The prostheses tested were regular sized Miller-Galante total knees mounted on 316L stainless steel fixtures using bone cement. An environmental chamber surrounded the knee and maintained bovine serum lubricant at 37 degrees C. The specimens were tested using consecutive blocks of 464 level walking steps, 8 ascending stairs and 8 descending stairs for a total of 100,000 steps. The wear mechanisms found on the tibial components were scratching, carbon-fiber associated damage, surface deformation, pitting, minor abrasion, and delamination. Three forms of carbon fiber associated damage were identified; fibers pulled from the surface, broken fibers, and UHMWPE removed from the surface fibers. The SEM evaluation revealed a pit forming mechanism. No correlation was found between femoral component material and tibial surface damage. Visual examination of the femoral components revealed no signs of wear or scratching on the cobalt-chromium-molybdenum or TiN-coated Ti-6A1-4V components. There were, however, many light surface scratches on the uncoated Ti-6A1-4V components, which were also observed in a supplementary test of an uncoated Ti-6A1-4V component tested with a conventional polyethylene tibial component.

Alloys↗
PubMed1987

Antibiotic prophylaxis in open-heart surgery patients: comparison of cefamandole and cefuroxime.

The efficacy of cefamandole and cefuroxime in preventing postoperative wound infections was compared in 3037 patients undergoing open-heart surgery. Antibiotic prophylaxis in 1467 patients having coronary artery bypass and valve replacement surgery was cefamandole 2 g iv preoperatively followed by 2 g q6h for five days postoperatively; 1570 patients received cefuroxime 1.5 g iv preoperatively then 1.5 g iv q 12h for three days postoperatively. Postoperative wound infections (sternal and leg wounds) were studied in each treatment group. In the cefamandole study group, 27 patients (1.8 percent) developed postoperative wound infections (9 sternal and 18 leg wounds). In the cefuroxime treatment group, 19 patients (1.2 percent) developed postoperative wound infections (9 sternal and 10 leg wounds). Overall, no statistical difference was found between the two antibiotics in preventing postoperative wound infections. However, in patients having valve replacement surgery, cefuroxime was found statistically more effective than cefamandole prophylaxis in preventing sternal wound infections (no infections in 284 patients compared with five infections in 205 patients, respectively, p = 0.01). The most common organism isolated from infected wounds with cefamandole was Staphylococcus aureus followed by S. epidermidis compared with cefuroxime which had S. epidermidis followed by S. aureus. Cefuroxime was found to be as effective as cefamandole and considerably less expensive in preventing postoperative wound infections in patients undergoing open-heart surgery.

Cardiac Surgical Procedures↗
PubMed1986

Reducing prophylactic antibiotic costs in cardiovascular surgery: the role of the clinical pharmacist.

A project was undertaken to demonstrate significant drug cost savings from clinical pharmacy services. The method of identifying and documenting the problem and the presentation and implementation of the project are discussed. The cost savings of the project are presented, including the economic impact on the patient and institution. The clinical pharmacist, the key figure in the success of the project, presented a complete pharmacological and financial analysis of the project to the medical staff. The project resulted in a financial savings of approximately $600 000/yr to patients in decreased drug charges, $200 000/yr in decreased drug purchases/inventory, and $105 000/yr to the hospital in an improved revenue/expense statement. This project represents an example of the important role of the clinical pharmacist in helping a hospital identify areas to reduce drug therapy costs. A future role for clinical pharmacists will be to work closely with the director of pharmacy, hospital administration, and medical staff in identifying and implementing cost-effective drug therapy.

Anti-Bacterial Agents↗