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Biomedical subjects

J A Bosso

Publications and source records attributed to J A Bosso.

At least 73 records · Page 4Linked to original sources
PubMed1985

Feasibility and cost savings of intravenous administration of aminoglycosides in outpatients with cystic fibrosis.

Hospitalization for some patients is often prolonged by days to weeks to complete a course of intravenous antibiotics. This is true with CF patients' who usually receive aminoglycosides throughout their hospital course. This study assesses the practicality and cost effectiveness of intravenous aminoglycoside therapy in outpatients with CF. Fifteen patients were discharged from the hospital a total of 31 times with up to three days of antibiotic, preloaded in syringes, to be administered with a portable syringe pump that delivered a dose over 40 minutes. A total of 242 drug infusions were self-administered in this manner. Flow-rate data indicated that the pumps infused at a rate within +/- 8% of their nominal rate. During the 31 courses of treatment, intravenous catheters had to be replaced on 11 occasions, but four of these episodes occurred in one patient who was treated at home for 36 days. Two malfunctions of the infusion system occurred, as did six catheter site reactions. The cost of preparing drug doses for outpatient use of this system and rental of the pump is not only less than that for in-hospital administration with piggy-back bottles (approximately $20 vs. $30/d, respectively), but totally negates the cost of the hospital room (approximately $200/d). Outpatient administration of aminoglycoside by controlled intravenous infusion is not only convenient and safe, but results in considerable cost savings.

Adolescent↗
PubMed1985

Stability of clindamycin phosphate and ceftizoxime sodium, cefoxitin sodium, cefamandole nafate, or cefazolin sodium in two intravenous solutions.

The stability and compatibility of clindamycin phosphate and ceftizoxime sodium, cefoxitin sodium, cefamandole nafate, or cefazolin sodium in two intravenous solutions were studied. Each antibiotic alone as well as each of the four two-drug combinations were examined when mixed in duplicate 100-mL glass bottles of 5% dextrose and 0.9% sodium chloride injections. Antibiotic concentration, pH, and visual appearance were recorded at the time of preparation and at 1, 4, 8, 12, 24, and 48 hours. Antibiotic concentrations were assessed with drug-specific high-performance liquid chromatographic assays. Decreases in concentration of 10% or more from the original concentration were considered to indicate instability. All the single antibiotic solutions were stable for 48 hours. Clindamycin was stable in all combinations except with ceftizoxime in 0.9% sodium chloride injection, which measured 89.3% of its original clindamycin concentration at 48 hours. All the cephalosporins mixed with clindamycin were stable for 48 hours. Clindamycin is stable for at least 48 hours when mixed with cefoxitin sodium, cefamandole nafate, or cefazolin sodium in either 5% dextrose or 0.9% sodium chloride injections and for at least 24 hours when mixed with ceftizoxime sodium in 0.9% sodium chloride injection.

Cefamandole↗
PubMed1985

Compatibility of clindamycin phosphate with cefotaxime sodium or netilmicin sulfate in small-volume admixtures.

The stability and compatibility of clindamycin phosphate plus either cefotaxime sodium or netilmicin sulfate in small-volume intravenous admixtures were studied. Admixtures containing each drug alone and two-drug admixtures of clindamycin phosphate plus cefotaxime sodium or netilmicin sulfate were prepared in 100 mL of 5% dextrose injection and 0.9% sodium chloride injection in both glass bottles and polyvinyl chloride (PVC) bags. Final concentrations of clindamycin, cefotaxime, and netilmicin were 9, 20, and 3 mg/mL, respectively. All solutions were prepared in duplicate and stored at room temperature (24 +/- 2 degrees C). Samples were visually inspected, tested for pH, and assayed for antibiotic concentration using stability-indicating assays at 0, 1, 4, 8, 16, and 24 hours for admixtures in glass bottles and at 0, 8, and 24 hours for admixtures in PVC bags. No substantial changes in color, clarity, pH, or drug concentration were observed in any of the solutions. Clindamycin phosphate is compatible with cefotaxime sodium or netilmicin sulfate in 5% dextrose and 0.9% sodium chloride injections in glass bottles or PVC bags for 24 hours.

Cefotaxime↗
PubMed1984

Azlocillin pharmacokinetics in patients with cystic fibrosis.

The pharmacokinetics of azlocillin were studied in 10 cystic fibrosis patients, ranging in age from 11 to 28 years. The patients received a 9- to 23-day course of 350 mg of azlocillin per kg in four or six divided daily doses in combination with am aminoglycoside. Blood and urine samples were collected at specified times after the last dose of the course of azlocillin therapy and then assayed for azlocillin content. Pharmacokinetic parameters were determined by noncompartmental analysis. Mean values for serum half-life (1.74 h), disposition constant (0.41 h-1), total body clearance (123 ml/kg per h), and renal clearance (58 ml/kg per h) were determined. All patients exhibited improvement with respect to clinical and laboratory parameters and displayed no adverse reactions. The pharmacokinetic analysis offers further evidence of the dose-dependent nature of azlocillin elimination, but elimination did not appear to be altered in cystic fibrosis patients.

Adolescent↗
PubMed1983

Cefoperazone pharmacokinetics in preterm infants.

The elimination pharmacokinetics of cefoperazone, a new cephalosporin, were studied in 15 preterm infants ranging in gestational age from 32 to 36 weeks and in postnatal age from 1 to 6 days. The infants received a single dose of either 50 or 250 mg of cefoperazone per kg by intravenous infusion. Blood samples were collected at specified times after completion of the drug infusion and then assayed for cefoperazone. Pharmacokinetic parameters were determined by noncompartmental analysis. Mean values for plasma half-life, elimination rate constant, apparent steady-state volume of distribution, and total body clearance were 5.53 h, 0.15 h-1, 124 ml/kg, and 36 ml/h per kg, respectively, for the group receiving a 50-mg/kg dose and 5.76 h, 0.14 h-1, 111 ml/kg, and 35 ml/h per kg, respectively, for the group receiving a 250-mg/kg dose. Positive correlations between gestational age and clearance and elimination rate were detected. A 50-mg/kg dose every 12 h ensured adequate serum levels for most of the common neonatal pathogens. Other than a transient rise in eosinophils in four subjects, no adverse effects were noted.

Anti-Bacterial Agents↗
PubMed1983

The role of the institutional review board in research involving human subjects.

Concern with the rights and welfare of human experimental research subjects has given rise to the evolution of institutional review boards. This article describes the basic composition and purposes of these boards, as well as the federal regulations by which they are governed. Since many of these regulations are open to interpretation, the policies and procedures of one such board are included to represent an example of how these regulations are interpreted and applied.

Documentation↗
PubMed1981

Delivery time in a decentralized pharmacy system without satellites.

The time required for pharmacy to deliver medications to the nursing unit under centralized and decentralized unit dose drug distribution (without satellites) systems was compared. Routing slips were attached to physicians' drug orders generated at a surgical nursing unit. Under the centralized system, the ward clerk sent the order to the pharmacy via pneumatic tube; the pharmacist received the order, transcribed it, and prepared the medication; and supportive personnel delivered the drug to the nursing station. The time required to perform each step was recorded on the routing slip for a five-week period. Under the decentralized system, the ward clerk placed the physicians' orders in the pharmacy box on the nursing unit. The pharmacist picked up the orders, filled them from a decentralized master medication cart, and placed the drug in the nurses' medication cart. Time required to complete the medication process was significantly less under the decentralized system than under the centralized system (54.15 +/- 42.82 versus 83.80 +/- 48.16; p less than 0.05).

Humans↗
PubMed1979

Decentralization of pharmaceutical services without satellite pharmacies.

The decentralization of pharmaceutical services without the addition of pharmacy satellites is described. Mobile, master medication carts are used by pharmacy personnel in the patient-care areas to fill the unit dose carts used by nurses. A combination medication administration record and patient profile eliminates duplication of effort by pharmacy and nursing. Responsibilities of pharmacists and technicians, the process of hospital-wide implementation of the system, current levels of service, and a clerkship designed to improve staff pharmacists' clinical abilities are described. The ratio of the number of drug doses administered to the number of drug doses handled per patient-day increased after the implementation of the new system. This indicated that individual doses were handled fewer times by pharmacy personnel. This method of decentralization permitted integration of distributive and clinical pharmaceutical services with a minimal personnel cost increase, no additional space requirements nor expenditures for renovation, and only a small cost for master medication carts. Because the pharmacists work in the patient-care areas, they are in more frequent contact with nurses, physicians and patients.

Costs and Cost Analysis↗
PubMedDate not supplied

Agreement between capillary and arterial serum gentamicin concentrations in neonates.

Due to inherent difficulties in blood sampling in neonates, specimens for laboratory analyses are often obtained by heel puncture technique. While agreement between venous or arterial and capillary concentrations of some substances has been reported, that for gentamicin, when obtained by heel stick, has not. Simultaneously obtained heel stick (capillary) and umbilical artery (arterial) serum samples were analyzed for gentamicin concentrations in 20 preterm neonates. Further, 14 subjects underwent manual manipulation of the heel to encourage blood flow before sampling to test the effect of such manipulation on gentamicin concentration. The agreement between capillary and arterial serum concentrations of gentamicin was found to be excellent in infants greater than 1000 g body weight. Manipulation of the heel had no effect on this agreement.

Arteries↗
PubMedDate not supplied

Efficacy of ciprofloxacin in patients with cystic fibrosis.

Twenty-five courses of oral ciprofloxacin were administered to 16 patients experiencing pulmonary exacerbations of cystic fibrosis in an open, uncontrolled trial of efficacy and tolerance. Patients were treated for 7-35 days and efficacy was evaluated based on changes in clinical score, white blood cell count, quantitative bacteriology of sputum, and pulmonary function tests. Most courses of therapy were associated with a positive response with changes in clinical score and forced expiratory volume in one second being statistically significant (p less than 0.05). No side effects to ciprofloxacin were noted. Emergence of bacterial resistance to ciprofloxacin was rare. Ciprofloxacin appears to be effective in patients with cystic fibrosis who are experiencing pulmonary exacerbations associated with susceptible bacterial pathogens.

Adult↗