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Biomedical subjects

D M Kirking

Publications and source records attributed to D M Kirking.

61 records · Page 4Linked to original sources
PubMedDate not supplied

Drug product selection: legal issues.

OBJECTIVE: To review the potential legal liability of the pharmacist in the drug product selection process. DATA SOURCES: Published articles identified through MEDLINE, published law reviews identified through InfoTrac, and appellate court decisions. Search terms used included pharmacist liability, drug product selection, and generic substitution. Additional articles, books, and appellate court decisions were identified from the bibliographies of retrieved articles and citations in appellate court decisions. DATA SYNTHESIS: Pharmacists engaging in drug product selection are civilly liable under three legal theories: negligence, express or implied warranties, and strict product liability. Potential criminal liability includes prosecution for insurance fraud, deceptive business practices, and violation of state drug product selection laws and regulation. CONCLUSION: Pharmacists increase their liability when engaging in drug product selection, but the increase is small. Still, the law continues to evolve as pharmacists seek expanded roles and responsibilities. When courts give closer examination to pharmacists' expanded role, it is likely that pharmacists' liability will increase.

Drugs, Generic↗
PubMedDate not supplied

Consultative total parenteral nutrition teams: the effect on the incidence of total parenteral nutrition-related complications.

A two part, prospective study was undertaken to establish the existing frequency of total parenteral nutrition-(TPN) related mechanical, metabolic, and septic complications in an institution with a consultative TPN team (group A) and to determine if increasing the involvement of the TPN team in patient monitoring and verifying adherence to TPN infection control guidelines would reduce the incidence of these complications (group B). The initial 28 consecutive patients were managed entirely by their primary physicians with the role of the TPN team limited to consultative activities while the next 29 patients receiving TPN were managed jointly by their primary physicians and the TPN team. Analysis of the results show group B to have a significant reduction in metabolic complications, decreased incidence of mechanical abnormalities, and approximately equal incidences of documented sepsis. However, when compared to the results of an institution in which the TPN team has complete control of TPN therapy, even the group B patients had a relatively excessive number of TPN-related complications especially in the categories of mechanical and metabolic abnormalities. Thus, consultative TPN teams do not necessarily ensure optimum TPN therapy and institutions using this approach to provide nutrition parenterally must be prepared to establish the incidence of TPN-related complications and to expand the involvement of the TPN team as required to control the frequency of these anomalies.

Aged↗
PubMedDate not supplied

Efficacy and safety of low-dose intravenous versus intramuscular vitamin K in parenteral nutrition patients.

Efficacy and safety of intravenous and intramuscular vitamin K were compared prospectively in patients receiving total parenteral nutrition. Sixty patients randomly received either a 1-mg daily iv injection (iv group) or a 10-mg weekly injection group (im group). Efficacy was determined by the prolongation of twice-weekly prothrombin (PT) and activated partial thromboplastin (APTT) times. The prolongation of both was not significantly different between the im and iv groups. The percent of PTs outside the normal range was not different for the two groups, although the iv group had more APTT values outside the range than did the im group (p = 0.002). The number of adverse reactions reported in the iv (5) and im (4) groups was also similar. Reactions were minor, not reproducible, and all patients recovered without sequelae. PT results from the iv and im groups were combined and compared to values from 28 patients in an earlier study who did not receive vitamin K. PTs in the no-vitamin K group were significantly prolonged over the vitamin K group (p = 0.0004). The results confirm that regular addition of vitamin K to TPN regimens decreases the incidence of elevated PTs. When administered appropriately, iv and im administration of vitamin K appear to be equally safe and effective in maintaining normal PTs and APTTs.

Female↗
PubMedDate not supplied

Utilization of electronic infusion devices in a university hospital.

Use of large-volume electronic infusion devices (EID) in an adult general hospital was compared with an established protocol to determine compliance. Data were collected during seven widely spaced inspections of the facility. Forty-six percent of 962 EID were observed to be employed inappropriately. Compliance was nearly identical for both pumps and controllers and for intensive care and non-intensive care areas. Four reasons for employing EID accounted for 48 percent of all inappropriate use. An estimated annual savings of +178,000 to +460,000 might be realized through strict protocol compliance.

Costs and Cost Analysis↗
PubMedDate not supplied

Pharmaceutical cost growth under capitation: a case study.

Rising drug spending has generated concern among purchasers and policymakers. This paper compares drug cost growth in a capitated system with that in managed care systems that generally did not place physicians directly at risk for drug spending. We focus on cost growth because a substantial body of literature indicates that managed care interventions that reduce the level of costs may not influence the rate of cost growth. Drug cost growth under capitation initially was below that of other systems but still above targeted rates. Over time the capitation rates rose, the amount of risk transferred to physicians declined, and spending growth accelerated.

Adolescent↗
PubMedDate not supplied

Efficacy of patient-controlled versus conventional analgesia for postoperative pain.

Patient-controlled i.v. administration and intramuscular administration of morphine sulfate were compared in a crossover study to determine their relative effectiveness in relieving postoperative pain. Twenty adult patients scheduled for abdominal surgery were randomly assigned to one of two groups; one group received i.v. morphine sulfate for 24 hours using a patient-controlled analgesia (PCA) device, after which they were given morphine sulfate i.m. for 24 hours. The treatment order was reversed for the other group. Amount of narcotic administered, respiratory rate, and levels of discomfort, activity, and sedation were assessed by the nursing staff every two hours. At the end of each 24-hour treatment phase, patients ranked their level of pain, amount of pain relief, level of sedation, ability to sleep, and ability to perform pulmonary toilet. Patients were also asked whether they preferred PCA or i.m. analgesic therapy for future surgery. Patients reported significantly less discomfort while using PCA than during i.m. morphine administration. No significant differences in amount of narcotic used, respiratory rate, nausea and vomiting, or levels of activity or sedation were noted for the two regimens. Patients' rankings of the two treatment modes did not differ significantly, but a majority of patients indicated a preference for future use of PCA. In these postoperative patients, administration of i.v. morphine sulfate by PCA was as safe as i.m. administration and possibly more effective in relieving pain.

Adult↗