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Biomedical subjects

J L Bootman

Publications and source records attributed to J L Bootman.

At least 55 records · Page 3Linked to original sources
PubMed1985

Meta-analysis: quantitative integration of independent research results.

Meta-analysis, a quantitative method of combining the results of independent research studies, is described as a method for reviewing research literature. Four steps are taken to summarize the research in an area. First, a thorough literature review is conducted to identify a group of research studies with the relevant treatment variable. Second, an effect size is calculated for each study. Third, an overall (composite) effect size is determined by a weighted combination of the obtained effect sizes. Fourth, a fail-safe N (the number of unpublished studies with opposing conclusions needed to negate the published literature) is calculated to assess the certainty of the overall effect size. Meta-analysis was applied to 33 studies of chymopapain in an illustrative example. The analysis produced a large effect size of 0.8082 and a fail-safe N of 214, indicating strong support for the effectiveness of the treatment with chymopapain. Meta-analysis can be a useful tool if it is used properly. It is particularly useful as an adjunct to other methods of review that are used in pharmacy practice.

Chymopapain↗
PubMed1985

Decision analysis applied to pharmacy practice.

The use of decision analysis is discussed as it relates to pharmacy practice. Decision analysis is a valuable approach to selecting a choice from among several uncertain alternatives. It encourages the practitioner to define his views explicitly and weigh the merits of each alternative. The decision maker lists the choices or options to be considered. These choices are incorporated into a decision tree with their probability of occurrence and the relative worth of each potential outcome (utility) to the concerned party. A limitation of the method is that utility values and probabilities are often estimated on the basis of the decision makers' biases. Examples of applying decision analysis to clinical and administrative choices in pharmacy practice are presented.

Bayes Theorem↗
PubMed1985

Leadership styles of hospital pharmacy directors.

The leadership styles of hospital pharmacy directors and the association between leadership style, participative management, and innovative pharmaceutical services were studied using a mail questionnaire. The questionnaire was sent to 570 randomly selected hospital pharmacy directors. Included were a validated instrument that measures task-oriented versus relationship-oriented leadership behavior and other questions about participation of staff members, innovative services, and respondents' personal characteristics. The response rate was 69%. The majority of respondents perceived their leadership as highly relationship-oriented as well as highly task-oriented. Respondents with the "high relationship-high task" leadership style had the highest scores for subordinate participation. There were no significant differences in scores for innovative services by leadership style. A positive correlation between scores for subordinate participation and scores for innovative services was demonstrated. Most hospital pharmacy directors used a management style in which relationships and staff participation were important.

Leadership↗
PubMed1984

Diffusion of innovation: computer technology in hospital pharmacy.

The diffusion of computer technology in hospital pharmacy departments was studied by surveying pharmacy directors in a randomly selected sample of 501 hospitals in the United States with at least 100 beds. Pharmacy directors were asked to indicate for which of 17 tasks a computer or memory typewriter was used in the pharmacy department. The time of first adopting computers in the department was compared with the predicted S adoption curve; adoption time was also correlated with characteristics of the hospital, pharmacy, and pharmacy director. Of the 417 respondents, 308 reported use of a memory typewriter or computer in the pharmacy. Fifty-one directors reported only memory-typewriter use, and 94 reported both computer and memory-typewriter use. Maintenance of patient census lists and patient billing were the most frequent uses of computers. The primary uses of memory typewriters were preparation of letters and labels. There was no significant difference in the actual and predicted S curves for time of adoption of computers. The number of months since first adopting computers was positively correlated with hospital bed size and the pharmacy director's number of years as a pharmacist, years in current position and with current employer, and number of subordinates; it was also positively correlated with number of pharmaceutical services and number of computer uses in the department. Computer technology is becoming more universally accepted in hospital pharmacy, and research on the diffusion of innovations suggests that acceptance will continue to increase.

Computers↗
PubMed1982

Application of cost-benefit and cost-effectiveness analysis to clinical practice.

This article is intended to introduce the reader to the concepts of CEA/CBA for purposes of evaluating innovative pharmacy services. Furthermore, sensitization to the issues surrounding CEA/CBA studies should allow the reader to be more discriminating in reviewing such reports in the literature. Rising costs for health care and the existence of limited resources are forcing policy makers to allocate resources in ways that maximize return-on-investment. It is felt by some that in the 1980s, researchers will be expected to answer the questions, "How much better is the innovation?" and "How do the expected benefits of an innovation compare with the benefits that could be obtained if the resources were used in some alternative way?" Part of the solution will require changes in the training and practice of health professionals. Future physicians, pharmacists, and others will need to acquire skills from the behavioral, social, and decision sciences (e.g., epidemiology, statistics, economics, decision analysis). The notion of cost-effective clinical decision making needs to be taught at all levels. Health practitioners involved with decision making at the level of the patient need to become more knowledgeable of the overall impact (regarding costs and benefits) of their decisions. Finally, evaluation of innovative pharmacy services is but one element of a management program for clinical services. Our attempt is not to deemphasize the need for studies documenting the value of clinical services, but rather to put evaluation in perspective with an equally important need, the need for development of an overall pharmacy program that is not only cost effective but efficient as well. The means to this end is a total management program integrating all pharmacy services.

Cost-Benefit Analysis↗
PubMed1982

Increased burn patient survival with individualized dosages of gentamicin.

The clinical effect of measuring serum gentamicin concentrations and individualizing each patient's dosage regimen was determined 105 burn patients with severe gram-negative sepsis. Thirty-nine patients (conventionally dosed group) received the recommended dosage regimen of 3 to 5 mg/kg/day from 1972 to 1974. From 1974 to 1976, serum concentrations were measured in 66 patients (individually dosed group), and each patient's dose was individually calculated to obtain therapeutic serum concentrations. All patients had normal renal function prior to initiation of gentamicin therapy. For each group, 16 independent variables were compared that may have influenced treatment response. The patients in the individually dosed group required an average dose of 7.4 mg/kg/day to achieve therapeutic concentrations, compared to the average dose of 4.4 mg/kg/day for the patients receiving conventional doses (P less than 0.001). An abrupt increase in patient survival occurred with the implementation of individualized regimens. Patient survival rates for the entire hospital course were 33% and 64% for the conventionally dosed and individually dosed groups, respectively (P less than 0.005). Survival rates for the first septic episode were 51.3% and 86.4%, respectively (P less than 0.001). Individualized gentamicin regimens, age, percent burn, and sex were the statistically significant variables related to patient survival for the first episode of sepsis. Age, percent burn, individualized dosing, complications during hospitalization, and a positive blood culture were significant factors related to patient survival for the entire hospital course. These data confirm the need for measuring serum gentamicin concentrations and adjusting dosages to ensure therapeutic levels and maximal efficacy of gentamicin in burn patients.

Adolescent↗
PubMed1982

Job satisfaction among hospital pharmacy personnel.

Job satisfaction of hospital pharmacists and of support personnel in two Arizona cities were compared. A survey composed of job-satisfaction measures that have been used in previous research was sent to all hospital pharmacy personnel (270 pharmacists and 208 support personnel) in Tucson and Phoenix, Arizona. Sixteen facet-free questions measured overall job satisfaction. Thirteen facet-specific indicators were measured. Differences were significant if p less than 0.05. Data from a national survey of hospital pharmacists and the general population were included for comparative purposes. Usable questionnaires were returned by 74.8% (202) and 62.5% (131) of the pharmacists and support personnel, respectively. Support personnel reported lower mean scores than pharmacists on all 13 facet-specific measures; 10 of these were significantly different. Pharmacists had a mean score of 3.0 (representing satisfied) on only two of the 13 facets, however. Age, sex, academic degree, position held, and tenure on present job had no effect on satisfaction for support personnel. For the pharmacists, consistent and significant differences were found in facet-specific measures relative to age, tenure, and position held. Clinical and research pharmacists reported the highest mean scores. Pharmacists in the 23-28 age group reported the lowest mean scores on all 13 facets. The most and least satisfied pharmacists were at their present job six years and 13-24 months, respectively. Pharmacists appeared to be more satisfied than support personnel on all facet-free measures, and about as satisfied as the general population in 1977. The authors concluded that since the successful role expansion of pharmacists will require a concurrent expansion for support personnel, efforts should be implemented to improve job satisfaction among support personnel.

Adult↗
PubMed1982

Job satisfaction and the future of pharmacy.

Reasons for the low levels of job satisfaction reported by hospital pharmacy personnel, the potential impact of this dissatisfaction on the profession, and possible solutions to the problem are discussed. Low levels of satisfaction among hospital pharmacists may be largely because of the manner in which pharmacy is practiced. While leaders in pharmacy have developed innovative programs and colleges of pharmacy have produced highly skilled practitioners, the practice of hospital pharmacy has not kept pace. Young practitioners may be disenchanted with pharmacy practice in the "real world" compared with their expectations, and they may not find their jobs mentally challenging. This may result in boredom, low motivation and commitment, and obsolescence of skills and abilities. To reverse the trend of insufficient mental challenge, the role of the hospital staff pharmacist sould be expanded to include some of the challenging functions presently performed by clinical pharmacists. This could be done by decentralizing pharmaceutical services so that pharmacists have more interaction with patients and other health practitioners. To alleviate dissatisfaction with advancement, a position hierarchy in the pharmacy could be established where pharmacists and support personnel would be promoted to a higher grade on the basis of merit, tenure, and demonstrated competence. Soliciting employee input at staff meetings may have a positive impact on satisfaction with hospital policies and practices. Finally, it is necessary for directors of pharmacy to develop the expertise to deal effectively with problems of human-resources management.

Job Satisfaction↗
PubMed1982

Physician and pharmacist attitudes toward medication use.

Pharmacist and physician attitudes toward the use of medication in various situations were compared. In May 1979, a questionnaire was sent to 300 pharmacists and 300 physicians randomly selected from practitioners licensed in Arizona. The questionnaire listed 25 statements regarding the use of medications in controversial situations; respondents were asked to rate their degree of agreement to each situation using a five-point scale. The data were factor analyzed, and a two-tailed Student's t test was used to test for significant differences between the mean physician and pharmacist response to each item (p less than or equal to 0.05). Demographic data were also collected. The response rate was 69%, representing 217 pharmacists and 198 physicians. Pharmacists had significantly more favorable attitudes toward medication use in seven situations, and physicians in six. When the data were factor analyzed, neither the pharmacist nor the physician responses showed intercorrelations that justified data reduction. The respondent's attitudes were polarized, since more than 25% of the pharmacists agreed and disagreed in 15 situations. The pattern held in 13 situations for the physician sample. Both the pharmacists and physicians reported a wide range of unpatterned attitudes regarding medication use. Further work is needed to improve the instrument used to measure attitudes in this study.

Attitude of Health Personnel↗
PubMed1981

Outpatient pharmaceutical services in academically affiliated hospitals and selected community hospitals.

The outpatient pharmaceutical services provided by university or medical school-affiliated hospitals and those offered by community hospitals were compared. A questionnaire was sent to a sampling of hospitals that had full-time pharmaceutical services. The hospital pharmacists were asked how frequently they performed 13 patient-oriented services. Four hundred community hospitals from 13 western states and 95 university hospitals nationwide were surveyed. The four null hypotheses tested were: (I) There is no difference between university and community hospitals in mean frequency of patient-oriented pharmaceutical services; (II) the mean frequencies of patient-oriented services are independent of hospital bed capacity; (III) the mean frequencies of patient-oriented services are independent of whether or not clinic outpatients are served by the outpatient pharmacy; and (IV) the mean frequencies of patient-oriented services are independent of the number of full-time equivalent pharmacists employed by the pharmacy. Performance of the 13 patient-oriented services was almost parallel for both the university and community hospitals. The only service that demonstrated a significant difference (p less than 0.05) between the two groups was "prescribing and renewing medication at the request of the physician." The most frequently performed services were to give patients oral medication instructions and drug information for the medical staff. Null hypothesis I was not rejected. A four-way analysis of variance was performed on null hypotheses II, III, and IV; II and III were rejected (alpha less than or equal to 0.05). Nevertheless, a one-way analysis of variance, post-hoc test, and t test revealed that the performance of patient-oriented services was more frequent in hospitals with less than 100 beds and in hospitals that provided outpatient services to clinic patients. Null hypothesis IV was not rejected.

Hospitals, Community↗
PubMed1980

Demographic characteristics of elderly drug overdose patients admitted to a hospital emergency department.

This study was undertaken to identify the demographic characteristics of patients aged 55 or older in a drug-overdose group admitted to the Emergency Department of Arizona Health Sciences Center during the 3-year period, August 1975-July 1978. Of the 646 overdose patients observed, 60 (9.5 percent) were aged 55 or older; of these, 77 percent were women--a significantly higher proportion than in the rest of the overdose group. The majority of the overdose incidents were unintentional, and most patients required hospitalization. For the elderly, the drugs involved in the overdoses did not differ significantly from those ingested by others in the overdose group. Concurrent traumatic injury occurred more often in the older age group, necessitating a longer hospital stay and higher health care costs. Drug overdosage is a significant problem in the elderly population. Since many overdose are unintentional, elderly persons in particular require the counsel of physicians and pharmacists in the medication process.

Aged↗
PubMed1979

Individualizing gentamicin dosage regimens in burn patients with gram-negative septicemia: a cost--benefit analysis.

Services provided by a clinical pharmacokinetics laboratory were evaluated in terms of an accepted cost--benefit model, and a model to evaluate clinical services provided by the pharmacist is presented. A retrospective study was conducted to evaluate the impact, in terms of patient outcomes, of individualizing gentamicin dosage regimens in severely burned patients. Analysis was conducted using multivariate statistical techniques and appropriate nonparametric and parametric tests to determine significant differences. This analysis provided the necessary data to quantify the impact of the pharmacokinetic service. The findings suggest that significant differences do exist in comparing individually dosed patients against those who were not, based upon discriminant and multiple regression analyses and/or nonparametric tests. Furthermore, the results will be useful for insurance companies, third-party payers, and government agencies in deciding which innovative clinical services should be reimbursed.

Burns↗