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Biomedical subjects

J F Dasta

Publications and source records attributed to J F Dasta.

At least 19 recordsLinked to original sources
PubMed1992

Computers in healthcare: overview and bibliography.

OBJECTIVE: The objective of this article is to provide an overview of computer technology and an associated bibliography, emphasizing institutional-based healthcare applications and pharmacoinformatics. DATA SOURCES: References were selected from the authors' files and from a computerized search over the last five years on computers in healthcare/medical informatics and in pharmacy. STUDY SELECTION: Articles selected for review and discussion were considered to be important contributions to the respective areas listed in the bibliography and representative of advancements in computer applications in healthcare and pharmacy. DATA SYNTHESIS: The computer has become an important support tool for healthcare professionals. Medical informatics and the discipline related to pharmacy, called pharmacoinformatics, have evolved from the cognitive underpinnings of medicine, pharmacy, and computer science. Recent developments in computer technology have resulted in computers that are fast, increasingly portable, and user friendly. Hospital information systems employ computers in various ways to deal with the vast amount of information used by various departments. Standards for electronic data exchange are being developed to increase the integration potential of these systems. Hospital pharmacists have used computers for drug distribution, financial analysis and inventory control, drug interaction detection, pharmacokinetic dosing, drug information, and drug therapy monitoring. Expert systems are being developed in several areas of drug therapy. Pharmacy educators have developed interactive courseware to help students learn problem-solving skills in the areas of calculations, therapeutics, and drug information. CONCLUSIONS: Pharmacists need to become more involved with applications of technology to pharmacy. Properly implemented, computers can provide more time for pharmacists to use their cognitive skills in the delivery of pharmaceutical care.

Clinical Pharmacy Information Systems↗
PubMed1992

Survey of ACCP members regarding use of computers and information processing.

A questionnaire was sent to a random sample of 480 members of the American College of Clinical Pharmacy to determine their opinions on various issues relating to computer technology and the future role of computers in information processing in pharmacy. Results from the 335 evaluable responses revealed nearly universal use of computers. Word processing was the most common application and IBM or compatible computers were the dominant machines. Respondents used a wide variety of generalized and specialized programs, especially electronic communication products. Computer technology is expected to have a major impact on routine aspects of pharmacy practice, although, respondents were split on its impact on more cognitively intensive functions.

Clinical Pharmacy Information Systems↗
PubMed1991

Postoperative course after sufentanil or fentanyl anesthesia for coronary artery surgery.

Postoperative hemodynamic effects were compared in 50 patients randomly selected to receive either sufentanil, 25 micrograms/kg, or fentanyl, 100 micrograms/kg, anesthesia for coronary artery bypass grafting. The two groups exhibited similar patient demographics; dose of premedicants and muscle relaxants; and use of inhalation agents. Values for 15 hemodynamic variables were recorded at baseline and at six postoperative times. The times to awakening, response to verbal commands, and extubation were also noted. Patients who received sufentanil had a more stable course, with higher cardiac outputs, lower systemic vascular resistances, and a lower incidence of hypertension. Postoperatively, the two groups had similar values for time to awakening, response to verbal commands, and extubation. Elimination half-lives differed significantly: 554 +/- 91 minutes (fentanyl) versus 277 +/- 60 minutes (sufentanil). Serum concentrations of both decreased linearly. The added advantages of postoperative hemodynamic stability could be important in the choice of anesthetic.

Anesthesia Recovery Period↗
PubMed1991

Experience with phenylephrine as a component of the pharmacologic support of septic shock.

OBJECTIVE: To evaluate the use of the selective alpha 1-adrenergic receptor agonist phenylephrine in the hemodynamic support of patients with septic shock. DESIGN: Retrospective analysis of clinical use of phenylephrine. SETTING: Surgical ICU in a university hospital. PATIENTS: Thirteen patients with septic shock (diagnosed by defined criteria) requiring pharmacologic support for the treatment of hypotension. INTERVENTIONS AND MAIN RESULTS: All patients underwent invasive hemodynamic monitoring followed by volume resuscitation and inotropic support to reverse flow-dependent oxygen consumption and lactic acidosis. Patients with persistent hypotension (mean arterial pressure [MAP] less than 65 mm Hg) and vasodilation (systemic vascular resistance index [SVRI] less than 1500 dyne.sec/cm5.m2 received phenylephrine at iv infusion rates of 0.5 to 9 micrograms/kg.min to maintain MAP greater than 70 mm Hg. MAP, SVRI, left ventricular stroke work index, and stroke volume index were significantly (p less than .05) increased after phenylephrine administration and at the time of highest oxygen consumption (VO2). Cardiac index was unchanged initially but increased at the time of highest VO2 (p less than .05). Pulmonary artery occlusion pressure and heart rate were unchanged. Average baseline VO2 increased from 145 to 200 mL/min.m2 and oxygen delivery (DO2) increased from 447 to 597 mL/min.m2 during phenylephrine treatment (p less than .05). Blood lactate concentrations decreased and urine output increased significantly (p less than .05), while serum creatinine concentrations remained unchanged during phenylephrine therapy. CONCLUSIONS: Treatment with phenylephrine was associated with beneficial hemodynamic effects when used to maintain perfusion, while increasing DO2 and VO2 in patients with septic shock.

Adult↗
PubMed1990

Accuracy and variability of intravenous theophylline preparations.

Numerous physiologic factors affect the disposition of theophylline. One nonpatient factor that can influence steady-state theophylline concentration is the administered dosage. The accuracy and variability of hospital pharmacy-prepared i.v. admixtures of theophylline has not been quantitated. A study was designed to evaluate variation in theophylline concentrations from two sources of theophylline admixtures--one by a hospital pharmacy i.v. room and one by a pharmaceutical manufacturer making a premade product. For the theoretical 1.6 mg/ml admixture, the mean theophylline concentration of the pharmacy-prepared solution was lower than that of premixed, whereas the absolute percent error of the premixed product was less than that of the pharmacy bags. For the theoretical 3.2 mg/ml admixture, the theophylline concentration of the premixed product was lower than that of both pharmacy products, whereas the absolute percent error of the pharmacy bags was less than that of the pharmacy bottles and premixed bags. Our data imply that variability in theophylline concentration can occur depending on the method of preparation, drug concentration, and formulation. Pharmacokinetic monitoring of theophylline should include an assessment of methods of i.v. drug preparation. Pharmacy departments should have a policy that assures consistency in the method of preparation of i.v. drugs.

Chemistry, Pharmaceutical↗
PubMed1990

Norepinephrine in septic shock: renewed interest in an old drug.

Vasopressors are the mainstay after fluids in the hemodynamic support of patients with septic shock. Although dopamine is commonly used in this situation, it is sometimes ineffective. Because of its potential adverse vasoconstrictive effects, norepinephrine usually has been chosen only when all other drugs have failed in septic shock. However, several recent reports have suggested a beneficial effect of norepinephrine, often in doses higher than those commonly used. Specifically, these studies in 77 patients showed that norepinephrine effectively elevates blood pressure and increases systemic vascular resistance without decreasing cardiac output. Renal function in these patients appears to be maintained. Information on oxygen transport is variable; however, the mortality from sepsis remains high at between 17 and 50 percent. Until more information becomes available, norepinephrine appears to be a useful drug in maintaining blood pressure in patients with septic shock, but higher than usual doses may be needed.

Animals↗
PubMed1990

High-dose phenylephrine infusion in the hemodynamic support of septic shock.

A 75-year-old man with hyperdynamic septic shock and vasodilation was successfully supported hemodynamically for 88.5 hours through the use of a continuous infusion of phenylephrine at dosages up to 360 micrograms/min. The only other vasoactive compound administered was dopamine at a dosage of 3.4 micrograms/kg/min. Hemodynamic evaluation indicated improvements in mean arterial pressure, cardiac output, and oxygen transport parameters during the period of hemodynamic support, which did not indicate a detrimental effect on perfusion of vital organs and tissues despite the use of this vasoconstrictor. Phenylephrine's pharmacologic properties may represent an advantage for its use as a vasoconstrictor over catecholamines such as norepinephrine and dopamine, particularly in patients who develop tachyarrhythmias with these agents. The pharmacology, dosage, and appropriate monitoring of therapy with phenylephrine in patients with septic shock are discussed.

Acute Kidney Injury↗
PubMed1990

Computers in critical care: opportunities and challenges.

Treating acutely ill patients in intensive care units (ICUs) requires assimilating large amounts of patient data. The computer can help process these data and display information in easy to understand formats. Also, knowledge-based systems can provide advice in diagnosis and treatment of common disorders in the ICU. For effective use of computers, systems must be integrated into the total hospital information system and computer data must logically become the primary medical record. Standards are being developed to aid in this process. Although computers have been used in the ICU for 25 years, most hospitals still use the paper medical record. Prototype systems such as the HELP, CARE, and PDMS systems are described. They are integrated ICU systems for computerizing most of the traditional functions in the ICU. Several commercial information management products are also described along with recently developed computerized drug and fluid delivery systems. Finally, prototype knowledge-based programs are presented that provide advice to the clinician on such topics as acid-base balance, hemodynamic monitoring, and shock management.

Artificial Intelligence↗
PubMed1990

Lidocaine local anesthesia for arthroscopic knee surgery.

Forty-five patients were evaluated during knee arthroscopy performed using local anesthesia produced by lidocaine with epinephrine to determine the dose-response relationship for operative analgesia. Serum lidocaine concentrations were also measured. Patients were randomized prospectively to receive 20 mL of 0.5%, 1.0%, or 1.5% lidocaine with epinephrine intraarticularly. Intraoperative discomfort was measured by verbal response on an 11-point linear pain scale. Pain scores were significantly higher in patients receiving 0.5% lidocaine during the first 45 min of surgery (P = 0.03). After 45 min, pain scores continued to be higher in the 0.5% lidocaine group than in the 1.0% or 1.5% groups, but the differences were not statistically significant. Ninety-four percent of patients in the 1.5% lidocaine group were willing to repeat this anesthetic technique for surgery compared with 83% of those in the 1.0% lidocaine group and 75% of those in the 0.5% lidocaine group (P greater than 0.05). The duration of postoperative analgesia was similar in all groups. Serum lidocaine concentrations before and 15, 30, 60, and 120 min after instillation of lidocaine were highest in the 1.5% lidocaine group with a peak concentration of 278 ng/mL. No patient had symptoms of lidocaine toxicity. We recommend that lidocaine concentrations of 1.0% or 1.5% be used when 20 mL is instilled intraarticularly for knee arthroscopy based on patient comfort and absence of lidocaine toxicity.

Adult↗
PubMed1989

Dobutamine: ten years later.

Dobutamine is a commonly used positive inotrope for the short-term management of heart failure. It is commercially available as a 50:50 mixture of two isomers with unique effects on alpha- and beta adrenergic receptors. In dosages of 2-15 micrograms/kg/minute, dobutamine has been shown to increase cardiac output (mainly through stroke volume), reduce systemic vascular resistance, lower central venous and pulmonary artery wedge pressures, improve renal blood flow, and relieve signs and symptoms of congestive heart failure. At higher dosages it can increase heart rate and induce arrhythmias. Recent evidence indicates that effects of dobutamine last long after the drug has been eliminated from the plasma, and some work has been done on ambulatory use of this agent. Dobutamine has been used successfully in several circumstances, such as after cardiac surgery, in patients with myocardial infarction, and in various shock states. An understanding of the pathophysiology of the underlying disorder is important in deciding which catecholamine to use. With this in mind, monotherapy or combination therapy with inodilators such as dobutamine, or inopressors like dopamine will follow logically.

Cardiac Output, Low↗