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D J Waller

Publications and source records attributed to D J Waller.

11 recordsLinked to original sources
PubMed1994

Role of quinine in the high mortality of intramuscular injection tetanus.

There has been considerable uncertainty about the risks and severity of tetanus after intramuscular quinine, a widely used treatment of severe malaria in the rural tropics. We have compared the clinical features and outcome of tetanus in which injection was the only apparent site of infection with tetanus acquired by other routes in patients admitted to the Centre for Tropical Diseases, Ho Chi Minh City, Vietnam. In 1081 consecutive patients with tetanus treated between Jan 26, 1989, and May 27, 1991, 27 followed intramuscular quinine and 15 followed injections of other drugs. Overall mortality was 26% (285/1081). Mortality in patients who had not had preceding injections was 24% (250/1039) compared with 96% (26/27) in the quinine group (relative risk 4.0, 95% CI 3.5-4.6) (p < 0.0001), and 60% (9/15) in the other injections group (2.5, 1.6-3.8) (p < 0.005). 21 patients (78%) in the quinine group died within 72 h of admission compared with 5 (33%) in the other intramuscular injections group (p < 0.01) and 4 (7%) of 54 matched controls (p < 0.0001). Tetanus that follows intramuscular injections has a poor prognosis, but when it follows intramuscular quinine it is usually rapidly fatal.

Adult↗
PubMed1993

Pharmacist clinical intervention program.

Our efforts have helped us demonstrate the positive impact of pharmaceutical care for patients. Our experience with the Clinical Notes section of our computer system leads us to recommend that such capabilities be sought in all pharmacy computer systems. A significant advantage to avoiding paper-based systems for documenting and collecting information relevant to clinical interventions, ADRs, DUE data, and patient outcomes has been proven in our institution. Various ways to categorize intervention data have been reported in the literature. We recommend clinical intervention categories be based on the eight categories of drug misadventuring so that data from different hospitals can be tabulated or compared. The success of our system is that it is one system rather than many systems. The importance of pharmacist documentation demands that it be simple, efficient, and painless, or it will be nonexistent.

Adverse Drug Reaction Reporting Systems↗
PubMed1992

Acute renal failure in patients with severe falciparum malaria.

Since 1988 in this referral center for severe cases of malaria for South Vietnam, a specialist team has managed malaria-associated renal failure (MARF) with peritoneal dialysis, and the mortality rate of MARF has fallen from 75% (78 of 104) to 26% (27 of 104) (P < .0002). Sixty-four patients with MARF (of whom 12 died) were compared to 66 patients with severe malaria whose serum creatinine levels remained < 250 mumol/L (six died). MARF had the clinical and biochemical features of acute tubular necrosis and was significantly associated with liver dysfunction (P < .05). A fatal outcome was associated significantly with anuria, a short history of illness, multisystem involvement, and high parasitemia. Most patients died from complications related to renal failure. Recovery of renal function was unrelated to parasitemia or hemoglobinuria; the median (range) time until urine output exceeded 20 mL/(kg.d) was 4 (0-19) days, and the time (mean +/- SD) for serum creatinine level to return to normal was 17 +/- 6 days. MARF can be managed effectively by prompt and careful peritoneal dialysis, but more effective dialysis or diafiltration might reduce the mortality rate further.

Acute Kidney Injury↗
PubMed1992

Hospital pharmacy staff development programs in Ohio.

Although staff development programs have been used to implement clinical services in Ohio hospital pharmacies, the majority of clinical services have been implemented without the use of staff development programs. The results of this study show that less than half of Ohio hospital pharmacy departments provide staff development programs. In those hospitals where the programs were provided, the average number of clinical services implemented through staff development was not significantly different from the average number implemented without these programs. Nor was there a significant difference in the average number of clinical services implemented through staff development between small hospitals (199 beds or less), medium hospitals (200 to 399 beds), and larger hospitals (400 or more beds); between government (city, county, or state) and private, nonprofit hospitals; and between hospitals whose staff development program coordinators were directors and hospitals whose coordinators were not directors. For the majority of departments that provided staff development programs, certification or testing of pharmacists was not required before providing clinical services. Results from the survey indicated that certification may not be necessary for all clinical services. Commitment to staff development programs in terms of management support and participation, awarding of continuing-education credit, and use in pharmacist performance evaluations was demonstrated by no more than 34 percent of all departments that responded. Financial commitment to these programs was low. Overall, since less than half of the departments reported providing staff development programs, the level of commitment to staff development appeared to be low.

Education, Pharmacy, Continuing↗
PubMed1989

Situational theory of leadership.

The situational theory of leadership and the LEAD instruments for determining leadership style are explained, and the application of the situational leadership theory to the process of planning for and implementing organizational change is described. Early studies of leadership style identified two basic leadership styles: the task-oriented autocratic style and the relationship-oriented democratic style. Subsequent research found that most leaders exhibited one of four combinations of task and relationship behaviors. The situational leadership theory holds that the difference between the effectiveness and ineffectiveness of the four leadership styles is the appropriateness of the leader's behavior to the particular situation in which it is used. The task maturity of the individual or group being led must also be accounted for; follower readiness is defined in terms of the capacity to set high but attainable goals, willingness or ability to accept responsibility, and possession of the necessary education or experience for a specific task. A person's leadership style, range, and adaptability can be determined from the LEADSelf and LEADOther questionnaires. By applying the principles of the situational leadership theory and adapting their managerial styles to specific tasks and levels of follower maturity, the authors were successful in implementing 24-hour pharmacokinetic dosing services provided by staff pharmacists with little previous experience in clinical services. The situational leadership model enables a leader to identify a task, set goals, determine the task maturity of the individual or group, select an appropriate leadership style, and modify the style as change occurs. Pharmacy managers can use this model when implementing clinical pharmacy services.

Behavior↗
PubMed1986

Assuring the quality of a clinical pharmacokinetics service.

A quality assurance program for a clinical pharmacokinetics service that meets current Joint Commission on Accreditation of Hospitals (JCAH) requirements for quality assurance is described. The clinical pharmacokinetics service is provided by pharmacists who have been certified through a staff development program. The clinical pharmacokinetics quality assurance program is part of the department's overall quality assurance program. Information from records maintained by pharmacists who are involved in the pharmacokinetics service is reviewed monthly and compared with 14 criteria that were approved by the pharmacy and therapeutics committee. Results of the monthly audits are summarized in a trend report; these results are communicated to the pharmacists involved, and any necessary corrective actions are taken. The program has led to more appropriate selection of target peak and trough serum drug concentrations, improved documentation of patient data, and better monitoring of each patient's renal function. Physician use of the service has increased as the quality of the service has improved. The quality assurance program has provided mechanisms for monitoring the quality of patient-care services and satisfying current JCAH requirements.

Hospital Bed Capacity, 100 to 299↗
PubMedDate not supplied

An open randomized comparison of intravenous and intramuscular artesunate in severe falciparum malaria.

An open paired randomized comparison of intramuscular and intravenous artesunate was conducted in 28 adult patients with severe falciparum malaria. The dose regimen in both groups was 2 mg/kg given immediately followed by 1 mg/kg at 12 and 24 h, and then daily until the patient could swallow. Both routes of administration were well tolerated and there was no evidence of toxicity. One patient in each treatment group died. Clinical and parasitological measures of recovery in survivors were similar in the 2 groups with mean fever clearance times of 37.3 h (standard deviation [SD] = 26.1 h) and 31.5 h (SD = 24.2 h) and mean parasite clearance times of 33.4 h (SD = 13.9 h) and 29.4 h (SD = 12.7 h) in the intravenous and intramuscular groups respectively. Artesunate is equally effective and well tolerated when given by the intravenous or intramuscular routes.

Adolescent↗