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Biomedical subjects

M G Scott

Publications and source records attributed to M G Scott.

At least 19 recordsLinked to original sources
PubMed1996

Using bar-code technology to capture clinical intervention data in a hospital with a stand-alone pharmacy computer system.

The use of bar-code technology to capture data on pharmacists' clinical interventions is described. At a hospital in Northern Ireland, patient-specific information could not be accessed through the pharmacy computer system. A system comprising six hand-held bar-code readers and software for downloading data was purchased. The pharmacy staff selected a range of fields for recording a wide array of data on clinical interventions, including the outcomes. Patient details that could not easily be bar-coded had to be recorded manually. The process was evaluated over three four-week cycles, with the data fields being revised after each cycle and the interventions being judged for their clinical appropriateness and their conformance to inhouse standards. After the third cycle, the need for manual recording of information was eliminated. A total of 857 interventions were made during the three cycles. Performance met or exceeded the standard for 7 (50%) of 14 indicators for the first cycle, 8 (53%) of 15 for the second cycle, and 13 (81%) of 16 for the final cycle. For all three cycles, the majority of the interventions were important and resulted in an improvement in the standard of care. A bar-code-driven data collection system successfully replaced a manual system for documenting pharmacists' clinical interventions.

Clinical Pharmacy Information Systems↗
PubMed1996

A pharmacokinetic and pharmacodynamic evaluation of buffered sublingual captopril in patients with congestive heart failure.

OBJECTIVE: The pharmacokinetics and pharmacodynamics of buffered sublingual captopril were assessed in patients with congestive heart failure (CHF). METHODS: The study was carried out in a randomised single-blind cross-over fashion (n = 6, 4 males and 2 females) and involved two study days, at least 7 days apart. Baseline measurements were carried out for plasma renin activity (PRA), blood pressure (B.P.) and heart rate (H.R.). Captopril (12.5 mg) was administered sublingually with dibasic potassium phosphate which maintained salivary pH at 7, or perorally with 100 ml of water. Further B.P., H.R. measurements and venous blood samples were taken over a 3 hour period post-drug administration. Blood samples were analysed for captopril and PRA levels. RESULTS: tmax after buffered sublingual administration of captopril, which ranged from 40-60 min (median = 40 min), was significantly shorter than after peroral administration (range 60-120 min, median = 90 min). Cmax was slightly greater after buffered sublingual than after peroral administration with mean values of 108.2 vs. 94.0 ng.ml-1. AUC values were similar after both routes of administration. Systolic and diastolic B.P. vs. time profiles for each administration method were significantly different i.e. sublingual administration produced an earlier reduction in B.P., however, HR did not differ significantly between the two routes. CONCLUSION: The data indicate that this novel administration method of captopril leads to an increased rate, but an unchanged extent of captopril absorption, suggesting a modest therapeutic advantage with the use of buffered sublingual captopril if a rapid reduction in blood pressure is required.

Administration, Sublingual↗
PubMed1996

Impact of point-of-care testing on patients' length of stay in a large emergency department.

We prospectively investigated whether routine use of a point-of-care testing (POCT) device by nonlaboratory operators in the emergency department (ED) for all patients requiring the available tests could shorten patient length of stay (LOS) in the ED. ED patient LOS, defined as the length of time between triage (initial patient interview) and discharge (released to home or admitted to hospital), was examined during a 5-week experimental period in which ED personnel used a hand-held POCT device to perform Na, K, Cl, glucose (Gluc), and blood urea nitrogen (BUN) testing. Preliminary data demonstrated acceptable accuracy of the hand-held device. Patient LOS distribution during the experimental period was compared with the LOS distribution during a 5-week control period before institution of the POCT device and with a 3-week control period after its use. Among nearly 15 000 ED patient visits during the study period, 4985 patients (2067 during the experimental period and 2918 during the two control periods) had at least one Na, K, Cl, BUN, or Gluc test ordered from the ED. However, no decrease in ED LOS was observed in the tested patients during the experimental period. Median LOS during the experimental period was 209 min vs 201 min for the combined control periods. Stratifying patients by presenting condition (chest pain, trauma, etc.), discharge/admit status, or presence/absence of other central laboratory tests did not reveal a decrease in patient LOS for any patient subgroup during the experimental period. From these observations, we consider it unlikely that routine use of a hand-held POCT device in a large ED such as ours is sufficient by itself to impact ED patient LOS.

Blood Chemical Analysis↗
PubMed1995

Audit of antibiotic usage in medium-sized general hospital over an 11-year period. The impact of antibiotic policies.

The objective of the present study was to evaluate trends in antibiotic expenditure over an 11-year period (1982-1992) in a 370-bed district general hospital in Northern Ireland and to examine the impact of two separate antibiotic policies on antibiotic usage. A further objective was to examine the attitudes of prescribers to the second policy. Drug utilization review was used to collect information on antibiotic expenditure and usage before and after introduction of separate antibiotic policies in 1985 (not intensively monitored) and 1989 (intensively monitored). A main questionnaire was used to determine the attitudes of prescribers. The first policy (1985) showed no benefits with regard to the number of antibiotic entities stocked (45 before, 45 after), number of dosage units issued (9.3% increase) or expenditure (33.3% increase). The 1989 policy led to significant reductions in the number of antibiotic entities stocked (28.9%), number of antibiotics issued (11.9%) and expenditure (6.1%). Expenditure began to spiral upwards when active monitoring of the second policy was suspended. The majority of prescribers (87.2%) who responded to the questionnaire (56.5% response rate) felt that the 1989 policy made a positive contribution to antibiotic usage in the hospital.

Anti-Bacterial Agents↗
PubMed1995

The effect of pH on the buccal and sublingual absorption of captopril.

The effect of pH on the buccal and sublingual absorption of captopril was evaluated using in vitro techniques and human studies. Partitioning of captopril into n-octanol was lowest over the pH range 5 to 8 and highest at pH values 3, 4 and 9. Using the buccal absorption technique, the partitioning of captopril (2 mg) was examined in six healthy male volunteers from buffered solutions (pH 3, 4, 5, 6, 7, 8, and 9). Lowest buccal partitioning occurred at pH 3 while maximal buccal partitioning occurred at pH 7. These data clearly indicated that the buccal absorption of captopril pharmacokinetic and pharmacodynamic parameters were determined after administration of buffered sublingual captopril (pH 7, optimal hP for absorption as determined from the buccal partitioning data) and unbuffered sublingual captopril. The study was performed in eight healthy volunteers in a randomised single-blind cross-over fashion. The tmax for captopril was found to be approximately 11 minutes earlier after buffered versus unbuffered sublingual administration and AUC0-30 min increased by approximately 30% in the case of buffered captopril. Cpmas, AUC0-180 min and relative bioavailability did not differ between the buffered and unbuffered administration. Pharmacodynamic parameters (BP, heart rate and plasma renin activity) did not differ significantly between buffered and unbuffered sublingual administration. The increased rate of captopril absorption after buffered sublingual administration was small and is likely to offer little therapeutic advantage over conventional sublingual formulation.

1-Octanol↗
PubMed1995

Current status of US programs for training clinical laboratory scientists and anticipated impact of healthcare reform.

We surveyed directors of medical technology (MT) and postdoctoral clinical chemistry (CC) training programs and of clinical pathology (CP) and combined anatomic/clinical pathology (AP/CP) residency programs regarding the number, quality, training emphasis, and job-placement experience of trainees for 1985-95 as well as the directors' opinions on the impact of "healthcare reform." Responses were received from directors of 94 of 249 (38%) MT programs, 14 of 15 (93%) CC programs, and 63 of 138 (46%) pathology residency programs. In all four categories the numbers of trainees have increased steadily over the last 5 to 7 years but are expected to remain stable or decrease slightly. Directors of MT and CC programs expect increasing difficulty placing their graduates; directors of AP/CP and CP residency programs do not. Although > 60% of MT graduates have entered private hospitals, this is anticipated to decrease, with a concomitant increase in university hospital placements. Of the AP/CP residents, > 60% and < 5% accepted service- and research-oriented positions, respectively. In contrast, 83% of CP residents entered university hospitals, with half of these taking research-oriented positions. Among CC graduates, 41% joined university hospitals and 10-15% accepted positions in each of either private hospitals or industry or reference laboratories. The emphasis of training varies, with clinical service and pathophysiology the major focus in AP/CP programs. CP and CC programs take two distinct approaches--some accentuating management, and others emphasizing research. Finally, MT program directors appear the most optimistic regarding the opportunities that healthcare reform may present.

Chemistry, Clinical↗
PubMed1995

Clinical utility of biochemical analysis of cerebrospinal fluid.

In addition to microbial culture, cytology, and immunological studies, physicians rely on the clinical chemistry laboratory for biochemical analysis of patients' cerebrospinal fluid (CSF). However, apart from routine glucose and protein determinations, the clinical value of other CSF analytes is often unclear. Here, we review the literature pertaining to the use of CSF biochemical measurements in managing patients with infectious disease, neoplasia, stroke and trauma, and dementia. Although a small number of studies demonstrate potential usefulness of some markers, we conclude that, without further study, the data are insufficient to support the routine clinical use of most of the analytes examined.

Central Nervous System Neoplasms↗
PubMed1994

Evaluation of a new colorimetric assay for serum lithium.

Using patient samples (n = 175) collected in our clinical chemistry laboratory, we have undertaken an analysis of a new colorimetric dry slide-based serum lithium (Li+) assay from Eastman Kodak for its Ektachem instrumentation series. Analyzer imprecision was acceptable, and good correlation was seen between the Ektachem assay and an ion-selective electrode (ISE)-based assay currently in use in our laboratory (r = 0.99). At all concentrations tested, potassium (K+), triglycerides, or bilirubin did not detectably interfere with the Ektachem determination of Li+. At concentrations within the reference range (135-145 mmol/L), sodium (Na+) did not affect the Ektachem Li+ determination. A slight Na(+)-dependent positive bias in the Li+ determination was evident at 157 mmol/L, but became clinically significant (> or = 0.2 mmol/L) only at physiologically extreme concentrations (> 188 mmol/L) of Na+. Very high concentrations (> 325 mg/dl) of hemoglobin also were found to cause a clinically significant positive bias. We conclude that the determination of Li+ by the Kodak Ektachem is precise, accurate, and adequately free from bias due to common interferents or other monovalent cations, and, therefore, is an acceptable alternative to currently available methods for the monitoring of serum LI+.

Bilirubin↗
PubMed1994

Pulmonary aspiration in mechanically ventilated patients with tracheostomies.

The purpose of this descriptive study was to evaluate feeding aspirations in adult patients receiving long-term mechanical ventilatory support, including the incidence of aspirations, the frequency of silent (clinically inapparent) aspirations, and differences between aspirators and nonaspirators. Aspiration data were determined by review of videofluoroscopic (VF) tapes of modified barium swallow procedures performed on 83 medically stable patients admitted to a chronic ventilator unit. Demographic and clinical variables were obtained from review of subjects' medical records. Forty-two subjects (50 percent) aspirated during VF testing and 37 of 48 (77 percent) aspirations were silent. Subjects who aspirated were significantly older than those who did not aspirate (p = 0.007). Swallowing disorders were common, particularly disturbances of the pharyngeal phase. We conclude that feeding aspiration is seen frequently in patients with tracheostomies receiving prolonged positive pressure mechanical ventilation. Advanced age increases the risk of aspiration in this population. Episodes of aspiration are not consistently accompanied by clinical symptoms of distress to alert the bedside observer to their occurrence.

Adult↗
PubMed1994

Endogenous serum antibodies that interfere with a common thyroid hormone uptake assay: characterization and prevalence.

We identified individuals whose serum contained a substance that produced falsely decreased thyroid hormone (T)-uptake values determined by the Emit (Syva) procedure. Investigation of this interference was prompted by identification of a patient with T-uptake values inconsistent with clinical assessment. IgG depletion and supplementation studies with this patient's serum suggested that the interference was due to endogenous antibodies with specificity for the thyroxine-glucose-6-phosphate dehydrogenase conjugate in the Emit T-uptake assay. The prevalence of the interference was examined by prospectively comparing routine Emit T-uptake values of 1710 patients' samples to T-uptake values obtained by another method. Discrepant samples were also assayed by a radioactive binding triiodothyronine-uptake assay. We identified eight samples that had falsely decreased T-uptake values by Emit, for an overall prevalence of 0.46%. Among 45 consecutive patients with a T-uptake value < 20%, five patients, or 11%, were falsely decreased by Emit and three of these were clearly due to an interfering IgG. We suggest that samples with abnormally low T-uptake values determined by the Emit method be confirmed by an alternative method.

Adult↗
PubMed1994

Interference in ionized calcium measurements by heparin salts.

We determined the suitability of various heparin salts used for anticoagulation of whole-blood specimens for measurement of ionized calcium (iCa), blood gases, and electrolytes. We were particularly interested in a new heparin product containing both zinc and lithium cations (CNLZ heparin), in which the binding sites with greatest affinity for divalent cations are bound with zinc and low-affinity sites with lithium. In initial experiments Li heparin decreased iCa concentrations 0.07 mmol/L at the lowest heparin concentration (3000 units/L) and progressively lowered them at higher concentrations. Zn heparin initially increased iCa concentrations 0.06 mmol/L but progressively lowered them as the heparin concentration was increased. Li heparin interfered even when present in amounts (9 units per 3-mL syringe) minimally effective in preventing coagulation. Use of CNLZ heparin (36 units per 3-mL syringe; Zn 63-78 g/kg of heparin) largely eliminated interference of heparin in iCa measurements. In studies that included the effects of concentration of heparin through partial filling of syringes, specimens anticoagulated with CNLZ heparin compared well with unheparinized controls in measurements of iCa, blood gases, and electrolytes. Blood gases and iCa results on CNLZ-heparinized specimens from intensive-care-unit patients also compared well with specimens anticoagulated with a preparation of heparin (EB heparin) in which calcium has been added to balance the calcium-binding capacity. However, the presence of calcium in EB heparin significantly increased measured total calcium concentrations, whereas the new CNLZ heparin did not interfere in total calcium determinations.

Arteries↗
PubMed1993

Clonal characterization of the human IgG antibody repertoire to Haemophilus influenzae type b polysaccharide. V. In vivo expression of individual antibody clones is dependent on Ig CH haplotypes and the categories of antigen.

Antibodies (Ab) to the polysaccharide capsule of Haemophilus influenzae type b (Hib-PS) provide protection against Haemophilus influenzae type b disease in children, and Hib-PS vaccines with different immunologic properties are widely used clinically. The repertoire of human anti-Hib-PS Ab induced by these vaccines is relatively restricted and can be divided into two types by the structure of the light chain V region. Ab using A2-V kappa II gene product, which account for the majority of anti-Hib-PS Ab response in most patients, show little somatic mutations. In contrast, non-Ab using A2-V kappa II gene product use VL genes from the V kappa I, V kappa II, V kappa III, V kappa IV, and V lambda subgroups, are variably expressed among patients, and contain somatic mutations. To further study the expression of these two types of anti-Hib-PS Ab, we have produced KB13, a mAb specific for V kappa II subgroup, and used mAb specific for various other VL subgroups to develop immunoassays specific for anti-Hib-PS Ab of each VL subgroup. When Ig allotypes were studied for the effect on the Ab repertoire, A2-V kappa II (A2) Ab were found to be expressed less in patients expressing fb or zag CH haplotypes (p < 0.05). When the T cell-independent Hib-PS carbohydrate vaccine was compared to two T cell-dependent Hib-PS protein conjugate vaccines for their effect on Ab repertoire, Ab using V kappa III VL were found to be more often elicited with the conjugate vaccines than with the Hib-PS carbohydrate vaccine (p < 0.01). Thus, individual members of the anti-Hib-PS Ab repertoire differ not only in their V region structure but also in the control of their expression.

Adult↗
PubMed1993

A comparison of Agiolax and lactulose in elderly patients with chronic constipation.

In a double-blind crossover study the efficacies of Agiolax, a combination of fibre and senna pod, and lactulose were compared in 77 long-stay elderly patients with chronic constipation. Mean daily bowel frequency, stool consistency and ease of evacuation were significantly greater with Agiolax than lactulose. The recommended dose was exceeded more frequently with lactulose than Agiolax (chi 2 = 8.38, p < 0.01). Adverse effects were not different for the 2 treatments. In long-stay elderly patients with chronic constipation Agiolax and lactulose were well tolerated, but Agiolax proved a more effective treatment.

Aged↗