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Biomedical subjects

L A Wanke

Publications and source records attributed to L A Wanke.

At least 19 recordsLinked to original sources
PubMed2000

Direct and indirect costs of rheumatoid arthritis to an employer.

This study is among the first to estimate the overall economic burden of rheumatoid arthritis (RA) from an employer perspective. The annual, per capita cost of RA was determined for beneficiaries of a major employer by analyzing medical, pharmaceutical, and disability claims data. The incremental costs related to RA were determined by matching RA patients to a case-control group of individuals with no recorded RA treatment. The utilization of health care services as well as the rate of disability among RA patients was substantially higher than among the controls. For example, annual, per capita employer expenditures for RA employees with disability were almost 3 times those for their controls ($17,822 vs $6131, respectively). Treatment to address not only the severity but also the progression of RA may substantially reduce overall employer expenditures for this disease.

Adult↗
PubMed1999

An assessment of the annual and long-term direct costs of rheumatoid arthritis: the impact of poor function and functional decline.

OBJECTIVE: To describe the distribution of direct medical care costs of rheumatoid arthritis (RA) over 1-year and 11-year periods, and to evaluate the impact of poor function and functional decline on direct costs. METHODS: The present study uses data from the University of California, San Francisco, RA Panel Study in which 1,156 persons with RA have been followed up for as long as 15 years through annual structured interviews and periodic updates on severity from rheumatologists. We present annual direct medical care cost data for the years 1995 and 1996 and estimates of cumulative costs for the period 1986-1996 for the 272 persons followed up continuously for this period. RESULTS: Medical care costs for RA averaged $5,919 a year from a societal perspective; persons with RA incur another $2,582 in medical care costs for non-RA reasons. Of the RA total costs, hospital admissions account for more than half. Costs are highly skewed, with the costs in the 90th, 95th, and 100th percentiles totaling $8,209, $31,059, and $85,469 a year, respectively. Cumulative costs for the period 1986-1996 averaged $57,201, with cumulative costs in the 90th, 95th, and 100th percentiles totaling $114,844, $142,563, and $191,540, respectively. Persons with RA in the worst quartile of function experienced total annual direct costs that were 2.55 times as high and total hospital costs that were 6.97 times as high as those in the best (e.g., the first) quartile. Poor baseline functional status and declining functional status had similar, large effects on cumulative medical care costs. CONCLUSION: Medical care costs for RA over 1 year and 1 decade are highly skewed. Persons with RA with poor and declining function experience much higher costs of care.

Arthritis, Rheumatoid↗
PubMed1998

Quality of life and cancer pain: satisfaction and side effects with transdermal fentanyl versus oral morphine.

PURPOSE: To compare pain-related treatment satisfaction, patient-perceived side effects, functioning, and well-being in patients with advanced cancer who were receiving either transdermal fentanyl (Duragesic, Janssen Pharmaceuticals, Titusville, NJ) or sustained-release oral forms of morphine (MS Contin, Perdue Frederick Co, Norwalk, CT, or Oramorph SR, Roxanne Laboratories, Columbus, OH). PATIENTS AND METHODS: A total of 504 assessable cancer patients participated in this cross-sectional, quality-of-life study. Relevant elements of four validated scales were used--the Functional Assessment of Cancer Therapy-General (FACT-G) scale, the Brief Pain Inventory (BPI), the Medical Outcomes Study (MOS) questionnaire, and the Memorial Symptom Assessment Scale (MSAS)--as well as original scales that were developed and validated for this study. RESULTS: The majority of patients in both treatment groups had late-stage (IV/D) cancer. Patients who received transdermal fentanyl were more satisfied overall with their pain medication than those who received sustained-release oral forms of morphine (P = .035). Fentanyl patients also experienced a significantly lower frequency (P < .002) and impact (P < .001) of pain medication side effects. These results occurred despite the fact that cancer patients who received fentanyl were significantly older (P < .001) and had significantly lower functioning and well-being scores (P = .001). Measures of pain intensity, sleep adequacy, and symptoms demonstrated no significant differences between treatment groups. CONCLUSION: These data suggest that patients are more satisfied with transdermal fentanyl compared with sustained-release oral forms of morphine. A lower frequency and reduced impact of side effects with transdermal fentanyl may be one reason cancer patients who receive fentanyl are more satisfied with their pain management.

Administration, Cutaneous↗
PubMed1998

Designer drugs: the evolving science of drug discovery.

Drug discovery and design are fundamental to drug development. Until recently, most drugs were discovered through random screening or developed through molecular modification. New technologies are revolutionizing this phase of drug development. Rational drug design, using powerful computers and computational chemistry and employing X-ray crystallography, nuclear magnetic resonance spectroscopy, and three-dimensional quantitative structure activity relationship analysis, is creating highly specific, biologically active molecules by virtual reality modeling. Sophisticated screening technologies are eliminating all but the most active lead compounds. These new technologies promise more efficacious, safe, and cost-effective medications, while minimizing drug development time and maximizing profits.

Biotechnology↗
PubMed1996

Strategic planning for applied pharmacoeconomics programs.

Escalating costs are changing the infrastructure in which health care is provided. Managed care programs are financing an ever-increasing share; rationing has already become reality in at least one state; and the federal government is once again examining the concept of a national health care plan. The primary goal of each of these initiatives is to control cost: the increasing cost of providing drug therapy is a major target. Increasing demands for shrinking resources will demand demonstration of value for money spent. Pharmacoeconomics provides a mechanism to establish the value of drug therapy. Using the strategic planning process, the Division of Pharmacy at M.D. Anderson Cancer Center and the Department of Pharmacy Services at Oregon Health Sciences University Hospital and Clinics have developed pharmacoeconomics programs to provide the focus for ensuring that every dollar spent on drug therapy and pharmaceutical services buys the best outcomes. These two case studies illustrate the processes for developing an applied pharmacoeconomics program and the activities such a program should embrace.

Cancer Care Facilities↗
PubMed1995

New approaches and technologies in drug design and discovery.

Traditional and novel approaches to drug design and screening techniques and strategies are described, and the potential benefits of new technologies are discussed. Sophisticated new approaches and technologies in the discovery and design of new drugs are replacing the traditional methods. Rational or structure-based methods of drug design and discovery that integrate techniques of x-ray crystallography, computational chemistry, and nuclear magnetic resonance spectroscopy are becoming the predominant methods. New technologies and methods for drug screening may yield significant savings in time and money, as well as increased diversity and specificity of lead compounds. Intense research activity is now being focused on small-molecule structure-based drug design, in which drugs would mimic the complex molecular interactions of natural proteins. The new approaches and technologies hold promise for dramatic therapeutic advances, particularly in the areas of transcriptionally active drugs and gene therapy. Rapid advances in drug design and screening, brought about through new technologies, may yield significant therapeutic advances and cost-effective therapies.

Biological Products↗
PubMed1990

Problems encountered in using written criteria to assess drug information responses.

Problems encountered in using written criteria to evaluate drug information responses during a study designed to determine whether simple requests were being unnecessarily submitted to a drug information center are described. Drug information questions that had been answered by a drug information center from June 1985 to June 1986 using defined references were chosen for evaluation. The center's responses to the 156 questions were paired with those of senior pharmacy students, who used the same references. Two experienced drug information pharmacists used a 6-point scale to evaluate the correctness, appropriateness, and completeness of each response, as well as the amount of extraneous material it contained. Interrater agreement was acceptable with respect to appropriateness, completeness, and amount of extraneous material; it was unacceptable with respect to correctness. When the judges re-evaluated the responses by using more explicit criteria for correctness, interrater agreement improved. The analysis excluded 32 responses that the judges found difficult to evaluate. Difficulties in assessing drug information responses arose from a lack of objective evaluation criteria, the wording of the request, the scope of the reference sources used, a lack of consistency between equivalent references, evaluator bias, and incomplete documentation. Efforts to determine whether simple drug information requests were being unnecessarily submitted to the drug information center were confounded by difficulty in using written criteria to judge the quality of responses.

Drug Information Services↗
PubMed1988

Comparative usefulness of MEDLINE searches performed by a drug information pharmacist and by medical librarians.

The usefulness of MEDLINE searches conducted by a drug information pharmacist who had received online training was compared with the usefulness of searches conducted by medical librarians. Searches for literature pertinent to select drug information requests received at a university drug consultation service during a three-month period were conducted independently by the pharmacist and one of three reference librarians. The three librarians had received extensive online search training and were experienced in conducting MEDLINE searches; the pharmacist was trained by a fourth experienced librarian-searcher using National Library of Medicine (NLM) training materials. For each drug information request, the pharmacist and the librarian searched two MEDLINE files on the NLM service. The printouts generated by the two searchers were evaluated by two drug information pharmacists in terms of how useful each list of citations would be in enabling the drug information pharmacists to answer the related question. The majority of printouts in 48 sets of searches were judged to be useful. Of the 96 possible "best search" votes (two votes for each of the 48 sets of printouts), the pharmacist's searches received 34 votes, the librarians' searches received 28 votes, and there were 34 tie votes. The numbers of useful primary and alternate citations were found to be the best predictors of whether a given printout would receive the "best search" rating. MEDLINE searches performed by a drug information pharmacist with online training, in response to drug information requests, were judged by drug information pharmacists to be as useful as searches performed by librarians.

Drug Information Services↗
PubMed1988

Financial support for poison control centers: a unique partnership with a chain drug store corporation.

The Oregon Poison Center has developed a unique partnership with a chain drug store corporation which sponsors the Center's poison prevention, public awareness, and professional education programs. Termed the Poison Prevention and Public Awareness Program, this affiliation offers significant financial support to the Oregon Poison Center on a continuing basis. It establishes an integral role for the drug stores in poison control activities. In addition, the program provides a mechanism for customer capture and reaps significant public and professional relation benefits for the corporation. This presentation describes the materialization of the affiliation, including the development of the program proposal, its presentation to potential participants, and the selection of a chain drug store corporation.

Financing, Organized↗
PubMed1987

Analysis and control of costs associated with answering drug information requests.

A strategy is proposed for estimating the average cost of answering drug information requests, comparing the factors that influence cost and controlling that cost. The cost for answering a request is based on the time it takes to answer the request, the salary of the person who answers the request, the cost of the information sources used to find the answer, and, indirectly, the frequency of requests of the same type. Request types have been defined by scope of search and formal of answer required, as textbook search/verbal answer, literature search/verbal answer, and literature search/written answer request. An empirical formula was used to calculate average costs for each request type at the Oregon Poison Control and Drug Information Center. A simple computer program was then used to generate costs over a range of changes that could be considered reasonable for each factor. The effect of modifying any of the factors in this formula demonstrated that a low volume of requests brings about the most critical change. Cost changes abruptly and may become unjustifiably high. If, for example, the volume of requests requiring literature search and verbal answer is 30 per month, the average cost for a request is $29.13; at a volume of 10 per month, the cost is $35.93; and at a volume of one per month the cost is $127.65. It is suggested that hospital pharmacy departments experiencing small frequencies of certain types of request analyze the cost in this manner and, if necessary, adopt a method for controlling the cost.

Costs and Cost Analysis↗
PubMed1987

An outbreak of watermelon-borne pesticide toxicity.

The largest reported United States outbreak of illness caused by a foodborne pesticide was due to aldicarb-contaminated watermelons. In Oregon, where the first episodes of toxicity were reported, 264 reports were received, and 61 definite cases were identified. Residues of aldicarb, a cholinesterase inhibitor, were found in 10 of 16 tested melons which had been eaten by persons meeting the case definition. The outbreak demonstrates the need for enhanced physician vigilance with respect to anticholinesterase intoxication. It also demonstrates the value of an established system for reporting of unusual illness to public health officials.

Aldicarb↗
PubMed1985

9-1-1 implementation: implications for poison center access.

House Bill 3178, passed by the 1981 Oregon Legislature, requires state-wide participation in a 9-1-1 emergency telephone system by 1991. It further requires deletion of all emergency telephone numbers other than 9-1-1 from the front cover of all telephone directories. The gradual implementation of 9-1-1 provided a unique opportunity to study telephone access to the poison center. The impact of 9-1-1 implementation was assessed, in a two-month survey of calls from the general public, to determine awareness of 9-1-1 availability and the source used to gain access to the poison center. Results showed that most callers (72%) had access to and were aware of 9-1-1. Callers obtained the poison center number from the telephone directories (28%), health care providers (19%), poison symbols supplied by the poison center (15%), directory assistance (9%), or other sources. Only 3% of the callers were referred from 9-1-1. State-wide implementation of 9-1-1 will have a major impact on the public's access to the poison center. The results of this study will be used to develop strategies for cooperation with 9-1-1 agencies.

Information Services↗
PubMed1984

A case of fatal strychnine poisoning.

Although rare today, poisoning from strychnine, both intentional and accidental, still occurs. A fatal case of self-poisoning with a strychnine preparation is presented. The case illustrates the dramatic presentation of strychnine poisoning, its rapidity of action, and the need for early aggressive treatment. The discussion centers on the pharmacokinetics, the mechanism of action, the signs and symptoms, and the treatment of poisoning from strychnine. The need for rapid diagnosis and the current recommended therapy for this poison are discussed.

Acute Disease↗
PubMed1983

Advantages and disadvantages of combining poison control and drug information centers.

The advantages and disadvantages of combining poison control and drug information centers are discussed. A major advantage of combining programs is a reduction in the overall cost of operation. Combined programs can share personnel, information resources, and sometimes space and utility charges. Combining programs can give the drug information service easier access to and justification for improved communication equipment and data-management equipment, and if it has an all-pharmacist staff, it can provide around-the-clock services. Combining programs can give the poison control service speedy access to the literature searching and evaluation skills of the drug-information specialist. One disadvantage, however, of a single staff providing both services, is that the staff may never achieve maximum skills in either discipline. Also, "jurisdictional" disputes can arise if there are two separate staffs. The more emergent nature of poison information requests may impair the efficiency of the drug-information component. The 24-hour expectation of drug information services can also place pressure on the poison information providers. The advantages of combining poison control and drug information services outweigh the disadvantages.

Cost Control↗