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Biomedical subjects

R A Hamilton

Publications and source records attributed to R A Hamilton.

At least 37 records · Page 2Linked to original sources
PubMed1992

Evaluation of patient-care interventions by Pharm.D. clerkship students.

A program is described in which Pharm.D. clerkship students provide pharmaceutical care by identifying drug-related problems, suggesting interventions to solve the problems, and documenting the patient's outcome. Four doctor of pharmacy degree students under the direct guidance of a clinical pharmacy preceptor suggested 231 patient-care interventions during their clinical rotations; 219 (94.8%) of the interventions were either fully or partially accepted by the prescriber. The most commonly solved drug-related problems were underdose (31.5%) and overdose (17.4%), followed by untreated indications (14.1%) and drug given without indication (13.7%). The remainder of the drug-related problems that the students solved were improper drug selection, failure to receive drug, adverse drug reactions, or drug interactions. All but 10 interventions were considered by preceptors to be significant contributions to patient care. The interventions were estimated to have decreased drug costs in 50.7% of the cases, increased drug costs in 23.7% of the cases, and not changed drug costs in 25.6% of the cases. Patient outcomes were documented by the students in 58.9% of cases; the desired goals of the accepted intervention were achieved in all documented cases. A preceptor-supervised intervention program was beneficial to Pharm.D. students and patients and was well received by prescribers.

Clinical Clerkship↗
PubMed1992

Use of prescription-refill records to assess patient compliance.

Prescription-refill records were used to assess patient compliance, to evaluate factors previously associated with compliance, and to determine the association between selected drugs and compliance. Records were selected from a computerized database containing prescription-coverage claims, based on the following criteria: (1) the prescriptions were refilled during 1987-1989 and within two times the days' supply after the dispensing date, (2) they involved any of 12 drugs selected for study, (3) they required one to four doses per day, and (4) at least 20 records with the same regimen were available. Compliance was defined as refill within 0.2 times the days' supply after the refill-due date, and it was assessed by calculating the compliance rate and the compliance index (which describes the relationship between the refill-due date and the actual refill date). Data from 19,118 prescription-refill records were analyzed. The compliance index improved slightly as the number of concurrent medications increased, worsened as the number of doses per day increased, and improved as the immediacy of the risk of noncompliance increased. Different medications and indications were associated with different degrees of compliance. Medication compliance generally improves as the number of daily doses decreases, may improve slightly as the number of concurrent medications increases, and varies with the particular drug and indication.

Drug Prescriptions↗
PubMed1991

Drug usage evaluation: H2-receptor antagonist use in 30 hospitals.

In this 30-hospital survey, data on usage, adverse drug reaction (ADR) rates, and drug interactions (DI) of the H2-receptor antagonists (H2RA) cimetidine, ranitidine, and famotidine were analyzed. Approximately 8% (1,768 patients) admitted to participating hospitals received an H2RA (range: 0.5 to 30%). Patients admitted to a critical care area were significantly (p less than 0.025) more likely to receive ranitidine, were more likely (p less than 0.005) to receive more than one H2RA, and were more likely (p less than 0.0005) to receive an H2RA for "stress ulcer" or a "history of peptic ulcer disease". Doses of the H2RAs were appropriate in less than 50% of cases. Sixty ADRs and 29 DIs were reported. There was no significant difference (p greater than 0.70) between cimetidine and ranitidine with regard to the number of ADRs reported; however, cimetidine was associated with a significantly greater (p less than 0.0005) number of reported DIs. The results of this utilization review indicate that H2RAs are frequently prescribed drugs in hospitalized patients. All ADRs and DIs were reported in patients in critical care areas, suggesting that these patients are "at risk" of developing side effects to H2RAs.

Adverse Drug Reaction Reporting Systems↗
PubMed1991

The management of bleeding in early pregnancy.

Ultrasound scan findings were analysed for 187 women referred to an emergency gynaecological scanning clinic during a seven month period, with bleeding in early pregnancy. One sixth of the women were not pregnant, one third had non-viable pregnancies and one half had viable pregnancies; 9% of this latter group subsequently miscarried. For the majority of women referred to the clinic, bed rest would have been inappropriate. In this study the value of bed rest and hospitalisation was considered uncertain for women with viable singleton pregnancies of 7-14 weeks gestation and bleeding in the previous 24 hours. Only 23 women with otherwise uncomplicated pregnancies met these criteria and consented to recruitment to a randomized controlled trial: three subsequently miscarried. Emergency scanning as a routine part of the gynaecological service is recommended, thus confining bed rest to those women with viable pregnancies. Reliable evaluation of bed rest and hospitalisation for such women will require a multicentre study.

Female↗
PubMed1989

Triplet pregnancy: a 10-year review of 105 cases at Harare Maternity Hospital, Zimbabwe.

During the 10-year period, 1975-1984, 105 triplet pregnancies were delivered at Harare Maternity Hospital, Zimbabwe, among 286,338 pregnancies in the Greater Harare Unit, giving an incidence of triplets of 1:2,727. The mean gestational age at delivery was 32.5 wk with 81 women (77.1%) delivering before 37 wk. Primigravidas delivered at a significantly earlier mean gestational age (P less than 0.05) and had a higher perinatal mortality (P less than 0.001) compared with grand multigravidas. Of the 315 babies, 277 (87.9%) weighed less than 2500 g. The overall perinatal mortality rate was 327%, with a perinatal mortality rate of 146% for infants weighing greater than or equal to 1000 g. Women hospitalised for bed rest during the antenatal period had fewer perinatal deaths compared with those diagnosed during the antenatal period, but not hospitalised for bed rest (P less than 0.02). No difference was found in the mean gestational age at delivery or the mean birth weights between these two groups. Among infants greater than or equal to 28 wk gestation there were fewer perinatal deaths in triplets delivered by cesarean section compared with triplets delivered vaginally (P less than 0.0004). This suggests that cesarean section may offer the optimal mode of delivery in triplet pregnancy.

Adult↗
PubMed1989

A prospective evaluation of cimetidine drug use.

A drug utilization evaluation (DUE) of cimetidine surveyed use, dose, route of administration, indications, and safety in five New York hospitals. Drug use and patient information were recorded on cimetidine data collection forms; data on indications were noted on physician response forms. In addition to FDA-approved indications, cimetidine was frequently used for non-approved indications substantiated by the H2-antagonist literature. Prophylaxis accounted for 42.5% of total use, followed by nonulcer (25.5%), ulcer (18.8%), and other indications (13.1%). Appropriateness of dosage could not be determined in 42 (16.1%) patients with insufficient creatinine clearance data. One hundred and thirty patients (49.8%) whose renal function could be estimated were within dosage guidelines; 89 (34.1%) were above or below dosage recommendations. The incidence of adverse effects was low (3.83%), although many patients were "at risk" of untoward events or drug-drug interactions.

Adolescent↗
PubMed1988

Heparin sodium versus 0.9% sodium chloride injection for maintaining patency of indwelling intermittent infusion devices.

In a double-blind study, heparin sodium was compared with 0.9% sodium chloride injection for use in maintaining patency of indwelling devices for intermittent intravenous infusion. Adult patients who required intermittent intravenous devices were randomly assigned to receive 1 mL of a heparin sodium 100 units/mL flush solution or a 0.9% sodium chloride flush solution. Observations were recorded for each catheter, rather than for each patient. Patients were evaluated daily for the development of phlebitis. In the 160 patients for whom complete data on catheter patency were available, there were 307 observations (170 for the heparin group and 137 for the sodium chloride group). No significant difference in the duration of catheter patency or incidence of phlebitis was observed between the groups. A difference in the incidence of phlebitis could not be excluded with confidence, but inasmuch as there was no effect on duration of catheter patency, the clinical importance of this superficial venous phlebitis is questionable. The duration of patency was significantly greater in men than in women. The use of penicillins, cephalosporins, or clindamycin, alone or in combination, was significantly associated with the development of phlebitis for both treatment groups. No other factors were found to correlate with either the duration of catheter patency or incidence of phlebitis. The results of this study indicate that heparin offers no advantage over 0.9% sodium chloride injection in maintaining the patency of intermittent intravenous devices.

Adult↗
PubMed1987

The unbooked patient. Part I. Reasons for failure to attend antenatal clinics.

Two hundred unbooked mothers were questioned after delivery and their reasons for non-attendance at antenatal clinics were determined. The control group consisted of 310 mothers who had booked early and were good clinic attenders. The most significant difference between the two groups was that the unbooked mothers were of lower socioeconomic status and lived in poorer areas situated further from the hospital. The main reasons given for not attending hospital clinics included the expense involved and the fact that the mothers often stayed outside the area during the pregnancy.

Adolescent↗
PubMed1987

The unbooked patient. Part II. Outcome of pregnancy in unbooked coloured patients.

The fetal outcome was compared in 200 unbooked pregnancies and in 310 pregnancies in which the mothers had booked before 22 weeks' gestation. Of the babies born to the unbooked mothers 36% weighed less than 2,500 g compared with only 12.5% in the booked group. Among the unbooked patients the neonatal mortality rate was three times higher than among booked cases. Maternal intrinsic factors, including parity and socio-economic status, made a major contribution to the incidence of low-birth-weight babies. The need for improved attendance at clinics and for education about antenatal care in the coloured population under review is well documented. The introduction of peripheral clinics and free antenatal care could play a major role in improving fetal outcome.

Adolescent↗
PubMed1986

Effect of the acetylator phenotype on amrinone pharmacokinetics.

Ten healthy male subjects were phenotyped with isoniazid for their acetylator status and then received intravenous amrinone at a dose of 75 mg during a period of 10 minutes. Blood samples were drawn at specified times during a 24-hour period after dosing. Plasma concentrations of amrinone were determined by a specific HPLC method. The plasma concentration data were fitted to a biexponential model by nonlinear regression. The mean apparent first-order elimination t1/2 for amrinone in the slow acetylators was 4.4 hours, whereas it was 2.0 hours in the fast acetylators (P less than 0.05). There was little difference in the volume of distribution at steady state. Clearance was lower in the slow acetylators, 16.6 L/hr, than in the fast acetylators, 37.2 L/hr (P less than 0.05). The AUC was higher for the slow acetylators, 4.96 micrograms X hr X ml-1, than for the fast acetylators, 2.20 micrograms X hr X ml-1 (P less than 0.01). Concentrations of amrinone and its N-acetyl metabolite in the urine from each volunteer were determined. The ratio of N-acetylamrinone to amrinone was calculated and, as expected, the fast acetylators had a higher ratio than did the slow acetylators (P less than 0.01).

Acetylation↗
PubMed1986

Two-point method for determination of aminoglycoside pharmacokinetics: theoretical and practical considerations.

A method is described that utilizes any two serum concentrations obtained during a multiple dosage regimen to estimate aminoglycoside pharmacokinetics. The accuracy of this method was tested theoretically using simulated patient data. In addition, the ability of this method to estimate gentamicin pharmacokinetics and predict serum gentamicin concentrations (SGC) in individual patients was evaluated and compared with the method of Sawchuk and Zaske. Based on the theoretical and patient data evaluations, reasonably accurate pharmacokinetic parameters were derived by the present method, especially when a pair of peak and trough SGC were utilized. In addition, the prediction error of this two-point fitting method (using pairs of peak-trough SGC) was not significantly different from that of the Sawchuk-Zaske method. These results indicate that the present two-point method (when using a pair of peak-trough SGC) provides a convenient and useful approach in individualization of aminoglycoside therapy in patients.

Aminoglycosides↗
PubMed1986

A primer on small area analysis.

As hospitals become more accountable to purchasers and consumers, they will need to be more responsive to legitimate questions about hospital use, costs, and quality. Small area analysis, because of its simplicity and ease of understanding, will be at the center of many of these discussions.

Catchment Area, Health↗
PubMed1986

Health care data and the MHA.

One area experiencing perhaps more change than any other at the MHA is data management. This article places these changes in perspective and outlines the current agenda for data management initiatives at the association.

Data Collection↗