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Biomedical subjects

R D Scalley

Publications and source records attributed to R D Scalley.

14 recordsLinked to original sources
PubMed2000

Rhabdomyolysis in a patient receiving the combination of cerivastatin and gemfibrozil.

Straightforward reports of unusual drug experiences are included in this section. While selected references may be cited, the purpose of a Drug Experience report is not to present an extensive review of the literature. A related section, Grand Rounds, includes papers that are well-documented patient case reports with a thorough review of the important literature to help put the case in perspective. Authors should report serious adverse drug reactions to the FDA medical products reporting program (MedWatch). Such reporting will not jeopardize the chances that AJHP will publish manuscripts on the same drug reactions.

Certification↗
PubMed1995

The use of ketorolac in lumbar spine surgery: a cost-benefit analysis.

The use of ketorolac was studied in patients undergoing lumbar laminectomy and those receiving lumbar fusion with or without instrumentation. Laminectomy patients in the ketorolac group used significantly less narcotic analgesic than did those in the narcotic treatment group. Ketorolac patients in both surgical categories experienced better pain control than narcotic group patients did. Laminectomy ketorolac patients experienced less sedation than did those in the narcotic group, and a similar trend was noted for fusion patients. A significant improvement in postoperative ambulation was demonstrated in the fusion ketorolac group. Postoperative total drug costs were significantly greater in both ketorolac treatment groups. A one-half day decrease in hospitalization was noted for laminectomy ketorolac patients. The overall annual financial impact of the use of ketorolac in lumbar spine patients is a net savings of $211,095.

Adult↗
PubMed1995

Treatment of postoperative wound infections following spinal fusion with instrumentation.

Postoperative wound infections following spinal fusion with instrumentation often present diagnostic and therapeutic difficulties. This article reviews 34 such infections. An infection rate of 3.7% was noted. Depending on various clinical indicators, treatment strategies included short-course antibiotics, prolonged intravenous antibiotics, or intravenous antibiotics followed by suppressive antibiotics and eventual hardware removal. To eradicate these infections, removal of instrumentation is often required; this option, however, may result in an unstable spine. Treatment algorithms were developed for treatment of postoperative spinal surgical site infections and to minimize the possibility of spine instability. All patients were cured of their infections.

Adult↗
PubMed1986

Is there cost reduction potential for extended half-life cephalosporins?

Two new second-generation cephalosporin derivatives with extended half-lives, ceforanide and cefonicid, have recently entered the U.S. marketplace. Because longer dosing intervals require fewer daily doses, potential exists for overall cost reduction if pharmacy and nursing time can be effectively saved. Reduction in personnel costs, however, must be sufficient for these more expensive products to be truly cost effective. We studied the impact of substituting these newer agents for older, less expensive products with formulary status at our 200-bed community hospital. Results show that no nursing expenses could be recovered, and there is little chance of consistently reducing pharmacy compounding expenses. Within the constraints of these studies, particularly physician prescribing habits, the GRASP (Grace Reynolds Application and Study of PETO) system of determining nurse staffing, and our drug acquisition costs, we find that the newer extended half-life products have very limited usefulness and may only increase the cost of antibiotic utilization.

Anti-Bacterial Agents↗
PubMed1985

The use of veterinary clinics for the education of pharmacy students.

The pharmacies of rural communities often include veterinary products; however, many pharmacists have little knowledge about animal diseases and the pharmacokinetics of drugs in animals. The Colorado State University at Fort Collins has developed an elective one-week rotation for pharmacy students through the University Veterinary Teaching Hospital. The four objectives of the program are: (1) to observe the various aspects of veterinary medicine and its use in different animal species; (2) to work with the student of veterinary medicine to plan and evaluate a drug therapy course; (3) to understand species variance in absorption, metabolism, and elimination of drugs; and (4) to plan and evaluate a course of therapy for an assigned animal, using the Problem Oriented Medical Record (POMR) format.

Anesthesia↗
PubMed1979

Interdisciplinary inpatient warfarin education program.

An educational program on warafarin counseling for inpatients of a 200--bed community hospital which uses both pharmacy and nursing personnel is described. Following a physician's request for the educational service, a registered nurse arranged for the patient to view a slide presentation of anticoagultants and provided a booklet designed to reinforce the learning objectives for the warfarin education program. After the patient viewed the film and read the booklet, a pharmacist or nurse made a follow-up visit to answer questions and reinforce the objectives. The checklist of learning objectives was completed by the pharmacist or nurse and remained in the patient's chart as a permanent record of medication counseling. Forty-five request for warfarin patient education were received during the program's first six months of operation. The pharmacist spent an average of 30 minutes with each patient; the nurse spent an average of 15 to 20 minutes with each patient. The average time required of nursing and pharmacy service to provide the program was one and two hours per week, respectively. The warfarin education program provides an important patient service with a reasonable expenditure of time by pharmacy and nursing personnel.

Hospitals, Community↗
PubMed1978

Acetaminophen poisoning: a case report of the use of acetylcysteine.

Acetylcysteine treatment of acetaminophen overdose (24--30 g) in a 31-year-old female is reported. Acetylcysteine was used to prevent acetaminophen-induced hepatotoxicity. An oral loading dose of 7 g of acetylcysteine was followed with oral administraton of 3.6 g every four hours for 17 doses. Liver enzymes were elevated on the fourth day after overdose. Phytonadione was administered on days four through six for elevated prothrombin time ratios. Only mild elevations of liver enzymes still were present on day seven. Previous case reports and studies of acetaminophen-induced hepatotoxicity and acetylcysteine therapy are reviewed. The use of acetylcysteine in this case appeared to be beneficial.

Acetaminophen↗
PubMed1977

Interdisciplinary diabetic team in a community hospital.

An interdisciplinary diabetic team which provides inpatient and outpatient diabetic instructional services in a 200-bed community hospital is discussed. The team consists of a pharmacist, a dietitian, and a registered nurse, each of whom is assigned to a specific area of diabetic education. Instructional objectives include coordination of teaching efforts by hospital personnel, standardization of education, and development of evaluation procedures. Upon notification of a physician request for diabetic team services, a form which contains competency-based instructional objectives and patient referral questions is placed in the patient's chart. Diabetic instruction may then be initiated by ward personnel or a member of the diabetic team. Outpatient classes are offered for those who desire or require additional or indepth instruction.

Adolescent↗
PubMedDate not supplied

Surgical antibiotic prophylaxis, patient morbidity, and cost reduction: a three-year study.

Twenty-five to 50 percent of all antibiotics prescribed for hospitalized patients are for prevention, not treatment, of infection. Procedures to institute rational, cost-effective utilization of these agents should have a significant impact on drug cost and pharmacy inventory. Several authors have described antibiotic cost reduction programs using pharmacy intervention. Unfortunately, measures that are successful in one institution may not be effective or appropriate in another. A three-year study was undertaken to examine the impact on physician prescribing of an infection control bulletin and formalized recommendation for antibiotic utilization. Patient records also were examined to determine if any change in antibiotic utilization would influence patient morbidity. Over the three examination periods there was a significant reduction in cost of prophylaxis in 7 surgical groups, and a trend toward cost reduction in 21 additional groups. Cost of prophylaxis also increased in other surgical groups. Cost reduction was associated with limited duration of prophylaxis and a shift toward use of first generation cephalosporin products. Patient morbidity did not differ significantly.

Anti-Bacterial Agents↗
PubMedDate not supplied

The impact of an i.v. team on the occurrence of intravenous-related phlebitis. A 30-month study.

A 30-month study of intravenous cannulation performed by I.V. team and non-I.V. team personnel demonstrates a significant and unpredictable benefit of an I.V. team. Beneficial effects include decreased volume and severity of phlebitis after infusion. The benefit appears to be most consistent on Medicine and Neuroscience services, inconsistent on Surgery and Obstetric/Gynecologic services, and not perceivable in Intensive Care Unit. The primary benefit appears to occur on those services that require the largest volume of venipunctures; these units account for approximately one half of all venipunctures performed. I.V. team benefit correlates well with increased team activity and, in contrast to other reports, does not correlate well with increasing incidence of phlebitis or cannula dwell time. A cost savings of approximately $17,000 per year related to a reduction in intravenous-related phlebitis due to I.V. team activity was demonstrated.

Humans↗