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Biomedical subjects

K B Roberts

Publications and source records attributed to K B Roberts.

At least 55 records · Page 3Linked to original sources
PubMed1988

Current and future delegation of pharmacy activities to technicians in Tennessee.

Pharmacists in charge of community and institutional pharmacies in Tennessee were surveyed to identify which activities they currently delegate to technicians and which activities they might consider delegating in the future. Survey questionnaires were mailed to all pharmacists-in-charge registered with the board of pharmacy. Respondents were asked to indicate which of 38 listed pharmacy activities were currently delegated to technicians and which currently undelegated activities would be delegated in the future if legal and policy barriers were removed and if technician training programs were available. Respondents also ranked six types of technician training programs in order of preference and were asked whether they thought technicians should receive official recognition through certification or licensure. A total of 947 questionnaires were returned, for a response rate of 62%. Of the 24 activities that were delegated by significantly different numbers of pharmacists in community and institutional settings, 23 were delegated more frequently by institutional pharmacists. Activities related to drug therapy were delegated least frequently by either group, although community pharmacists delegated the task of recommending nonprescription drugs more often than did institutional pharmacists. If barriers were removed and training programs were available, more pharmacists would delegate activities to technicians than currently do. Most respondents preferred a formal, in-house training program for technicians; more than 65% of pharmacists favored certification of technicians. Pharmacists in Tennessee currently delegate a number of activities to technicians, and more pharmacists would do so if barriers toward technician use were removed and if more trained technicians were available.

Pharmacies↗
PubMed1987

Relation between myocardial perfusion and left ventricular function following acute coronary occlusion: disproportionate effects of anterior vs. inferior ischemia.

This study examined the relation between left ventricular (LV) function and the severity of acute myocardial ischemia in a conscious dog model. The LV ejection fraction (EF) was measured by multigated equilibrium radionuclide angiography, and regional myocardial blood flow was measured with radioactive microspheres before and 10 minutes after distal and then proximal occlusion of the left anterior descending (LAD, 13 dogs) or left circumflex (LC, 13 dogs) coronary artery. Two methods were used to evaluate the extent of ischemia. The first method determined the mass of myocardium that was ischemic based on different degrees of reduced blood flow. The second method estimated the severity of ischemia expressed as blood flow deficit resulting from each coronary occlusion. Global LV function was very sensitive to ischemia, and the relation between change in function and the degree of ischemia were described best by linear functions. The best linear correlation between mass of ischemic myocardium and percent reduction in EF resulted from the ischemic region defined as all tissue with 25% or greater reduction in blood flow, r = 0.84 for LAD (Y = 0.96X + 1.8) and r = 0.75 for LC (Y = 0.53X + 2.0) occlusions. Defining ischemic mass by more severe reduction in blood flow resulted in exclusion of ischemic myocardium that affected function. The myocardial blood flow deficit also correlated linearly with percent reduction in EF, r = 0.89 for LAD (Y = 1.31X + 2.7) and r = 0.81 for LC (Y = 0.83X - 0.1) occlusions. The slope of the regression lines using both analyses of ischemia were significantly greater (p less than 0.01) for LAD than LC occlusions, indicating that for comparable degrees of ischemia LAD as compared to LC occlusion decreased EF to a greater extent. Calculation of EF from attenuated corrected volumes resulted in small changes in LAD, but not LC, EF and did not account for the disproportionate effects of LAD and LC ischemia. In a separate group of studies (n = 18) EF measured by radionuclide angiography after LAD or LC occlusions correlated well with biplane contrast angiography r = 0.93, SEE 5.1. These data suggest that disproportionately greater effects of LAD compared to LC ischemia on global EF in the dog are due primarily to different pathophysiologic responses to ischemia.

Animals↗
PubMed1985

A successful city-wide smoke detector giveaway program.

Each year, 5,000 Americans die and 300,000 are hospitalized as a result of 2.8 million residential fires. Almost all house fires allow time for safe exit if an early warning is given. Smoke detectors are an effective, reliable, and inexpensive method of providing such warning. After an upsurge of deaths related to fires in 1982, Baltimore City gave away 3,720 smoke detectors to households that requested them. This study addressed two questions: (1) Did the households that received the smoke detectors install them? (2) Was the population reached by this giveaway program a population at high risk from fire? A survey of 231 randomly selected households among those requesting smoke detectors was conducted 8 to 10 months after the giveaway program. At that time, smoke detectors were installed in 92% (212/231) of the homes and 88% (187/212) of the installed smoke detectors were operational. Households requesting smoke detectors were in census tracts at higher risk from fire. The correlation coefficient between the rate of requesting a smoke detector and the risk of death or injury related to fires was r = .90, P less than .001. The 231 surveyed households had more personal fire risk factors than the general population. The success of this smoke detector giveaway program is notable in that it required the active participation of a high-risk population.

Accidents, Home↗
PubMed1984

Relation between radionuclide angiographic regional ejection fraction and left ventricular regional ischemia in awake dogs.

Multigated equilibrium radionuclide angiography was used to quantitate global and regional ejection fraction (EF) in 26 awake dogs 10 minutes after distal and then proximal occlusion of the left anterior descending (LAD) or left circumflex (LC) coronary artery. Changes in global and regional EF were correlated with simultaneous measurements of the extent of acute left ventricular (LV) ischemia measured by radioisotope-labeled microspheres. The extent of ischemia, defined as the percentage of LV mass with greater than 25% reduction in blood flow from normal regional flow, was linearly related to the percent change in global EF after LAD (r = 0.84) and LC (r = 0.77) occlusions. The extent of ischemia also correlated with regional EF (r = 0.47 to 0.88 for LAD and r = 0.41 to 0.69 for LC occlusions). In 24 of 25 LAD occlusions and in all 20 LC occlusions that produced a measurable ischemic zone, the maximal percent change in regional EF exceeded the percent change in global EF. Two LAD occlusions and 2 LC occlusions reduced regional EF but not global EF. Thus, global and regional EF decreased in direct proportion to the extent of acute myocardial ischemia; regional ischemia produced greater changes in regional than in global EF.

Animals↗
PubMed1983

Urinary tract infection in infants with unexplained fever: a collaborative study.

Nine centers collaborated to determine the rate of urinary tract infection in infants with unexplained fever, to determine whether the rate is higher in febrile infants than in asymptomatic infants, and whether the yield justifies urine cultures in febrile infants. Urine cultures were done in 501 infants 0 to 2 years of age. The rate of confirmed urinary tract infections in the 193 febrile infants was 4.1%. All infections were in girls, with a rate of 7.4%. The rate of confirmed urinary tract infections in the 312 asymptomatic infants was 0.3%; again, all infections were in girls, with a rate of 0.7%. The rate in febrile girls was significantly higher than the rate in asymptomatic girls (P less than 0.01). The data support the advisability of culturing the urine of infant girls with unexplained fever.

Acute Disease↗
PubMed1983

The prognosis for patients with new-onset angina who have undergone cardiac catheterization.

We investigated the prognostic significance of new-onset angina in patients in whom coronary anatomic characteristics were known. New onset angina was defined as angina of less than 3 months duration. Consecutive patients (n = 1727) with significant coronary artery disease (diagnosed at cardiac catheterization) and who had not had a prior myocardial infarction or congestive heart failure were studied. In patients with new-onset angina (n = 329) there was a higher incidence of single-vessel disease (43% vs 27%) and a lower incidence of triple-vessel (23% vs 35%) and left main artery (5% vs 10%) disease compared with patients with chronic angina (n = 1398). Patients were classified by the presence or absence of preinfarction angina (severe and prolonged angina at rest requiring hospitalization to rule out myocardial infarction). In patients treated without surgery and who did not have preinfarction angina, survival at 1 year was 97% for patients with new-onset angina and 98% for those with chronic angina (p = .27). Among patients not treated surgically who did not have preinfarction angina, at 1 year 16% with new-onset angina and 7% with chronic angina had suffered a cardiac event (nonfatal myocardial infarction or death, p = .006). In patients treated surgically who did not have preinfarction angina, survival at 1 year was 96% both for those with new-onset angina and those with chronic angina (p = .99). The risk of an event in patients treated surgically at 1 year was not statistically different in patients with new-onset angina and those with chronic angina (12% vs 11%, p = .27). Survival and event-free rates were lower in patients with preinfarction angina than in patients who did not have it.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1983

Natural history of cerebral complications of coronary artery bypass graft surgery.

We reviewed 1,669 patients who survived coronary artery bypass graft surgery between 1969 and 1981. A total of 75 cerebral complications were identified, including (1) altered mental state, (2) stroke, and (3) seizure in 64 patients (3.8%). Altered mental state (delirium, hypoxic-metabolic encephalopathy) occurred in 57 (3.4%). Postoperative arrhythmias were associated with an increased risk of altered mental state. Cerebral infarction occurred in 13 (0.8%). Patients who suffered stroke had a higher occurrence of carotid bruits and history of peripheral vascular disease. Seizures occurred in five patients (0.3%). Mortality in patients with a neurologic complication was 29%.

Brain Diseases↗
PubMed1983

Hospital pharmacists' evaluation of drug wholesaler services.

Services provided by drug wholesalers were evaluated by hospital pharmacists. A survey was mailed to 1500 randomly selected pharmacy directors. Respondents indicated availability and use of 26 customer services. Pharmacists rated the services that they used on the basis of importance of the service and satisfaction with the service. The 644 returned questionnaires indicated that most services were available to a large majority of respondents. Most services used were rated as important or essential. Most respondents were satisfied with wholesaler services; the service with which the most respondents were dissatisfied was stocking of pharmaceuticals in single-unit packaging. Of other services that were widely used and rated important, prompt crediting for delivery errors, few out-of-stock items, frequent pickup of return merchandise, and stocking of injectable pharmaceuticals received low satisfaction ratings. Same-day delivery service and emergency delivery of prescription items were unavailable to more than 40% of respondents. Hospital pharmacists were generally satisfied with services provided by drug wholesalers. Wholesalers should be aware of the particular service needs of hospital pharmacists, and further studies of these needs should be conducted.

Commerce↗
PubMed1982

Considerations when proposing consultant pharmacist services to hospice programs.

Hospice programs attempt to provide a better quality of life by controlling the symptoms of dying patients. Pharmacist involvement with hospices has been limited and varies with each setting. This study identified opportunities where community pharmacists may provide services to the hospice patient and the hospice program. The routine functions of the visiting nurse included solving the drug therapy-related problems of hospice patients. Although pharmacists were relied upon for some assistance, their perceived role had been predominantly that of drug distributor. In addition, pharmacists were not aware of hospice programs and most offered very little help in meeting the needs of the terminally ill patient. Nurses stated that drug information was necessary when caring for hospice patients. After reviewing what the pharmacist could do for hospice patients, nurses indicated that they would request pharmacists' advice and assistance when drug therapy problems occurred.

Data Collection↗
PubMed1981

Effect of secretin on intestinal lymph flow and composition in the rat.

The effects of natural porcine and synthetic secretin, given by intravenous bolus or infusion, on intestinal lymph flow and protein composition in unanaesthetized rats were studied. Both forms of secretin increased lymph flow and protein output from the lymph fistula; dose-response relationships were determined. No change was observed in protein concentration in lymph or in the relative concentrations of large and small protein molecules during secretin-induced enhanced lymph flow, compared with the basal state. These results are in keeping with an increase in the functional exchange vessel area of the small intestine produced by secretin. It is possible that secretin may play a part in the hyperaemia and augmented intestinal lymph flow which occurs in the post-prandial period.

Animals↗
PubMed1981

Pediatrics in the community hospital.

The subject of the community hospital's pediatric service-its mission, organization and staff-is ripe for critical study and innovative implementation. The centripetal force of medical education which has kept the best medical school graduates within the tertiary hospital walls during medical school, residency, fellowship, and subspecialty practice has had a perhaps unintended though real inhibiting effect on the community hospital. Those who practice in the community environment may well be less equipped to study and change their world than are their academic counterparts. They often lack the training to do so, and lack time that can be taken from busy practice commitments. Those most capable of critical study are unfamiliar with or at least not always empathic to the community's problems. We suggest that there are many clinical questions and many organizational issues that are legitimate matter for study within community hospitals, in which a majority of the nation's children are cared for. The increasing number of affiliations between university and community hospitals may allow a true academic bond to develop and learning to occur at both ends. The community hospital has both the need and potential for important growth in the 1980s.

Allied Health Personnel↗