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Biomedical subjects

R J Michocki

Publications and source records attributed to R J Michocki.

30 records · Page 2Linked to original sources
PubMed1984

Audit of digoxin prescribing in ambulatory patients.

Digoxin prescribing for ambulatory patients with uncomplicated congestive heart failure in normal sinus rhythm (UCHF) was evaluated. The audit was conducted at a hospital primary care clinic and was performed retrospectively over a recent 2-year period. The audit focused on the discontinuance of digoxin prescribing and the attendant monitoring necessary. There was 34 patients prescribed digoxin during the study period who were classified as UCHF. Of these, 23 (68%) met our a priori criteria for digoxin discontinuance. However, only three of the 23 were discontinued and none met the criteria for proper follow-up. With regard to monitoring, the average patient was seen once every 2 months, but in fewer than half of the visits the patient was assessed on basic subjective and objective parameters of CHF status and digoxin toxicity. These results are being used in an educational program for the clinic physicians who before the audit had perceived their care of digoxin patients to be optimal.

Ambulatory Care↗
PubMed1981

Evaluation of antihypertensive drug prescribing in a primary care clinic.

Although the National High Blood Pressure Education Program has been in existence since the early 1970's, reported evaluation of drug prescribing for ambulatory, hypertensive patients for conformance with the stepped-care approach and approved drug labeling is lacking in the literature. To study this, charts of hypertensive patients from a primary care clinic were retrospectively reviewed against explicit treatment criteria. It was found that nearly all the antihypertensive drug prescribing was in accord with the criteria, with the exception of the scheduling of return visits to the clinic and monitoring. The community pharmacist's role in improving patient monitoring is discussed.

Ambulatory Care Facilities↗
PubMed1976

The care of decubitus ulcers pressure sores.

Despite a large volume of literature particularly directed toward treatment, pressure sores (including decubitus ulcers) remain a difficult problem, especially in the nursing home environment. The treatment of pressure sores is somewhat controversial and quite diversified. Selection of a successful therapeutic modality must be preceded by correct evaluation, i.e., whether the sore is superficial or deep, open or closed. The treatment of superficial sores is conservative and directed toward cleanliness, relief of pressure, and exposure to air. Surgical debridement may be indicated. Proteolytic enzymes often are employed as adjunctive therapy, although there are some major drawbacks to their use. The plethora of therapeutic agents suggested for the treatment of deep pressure sores probably is related to the difficulties in achieving success. Surgical debridement is indicated, and proteolytic enzymes are widely used. Possible interactions. and factors leading to the inactivation of these enzymes are discussed, as is the use of various solutions, ointments, gold leaf, oxygen, dry heat, and other adjunctive devices. Of paramount importance in the management of pressure sores is the maintenance of cleanliness and dryness.

Administration, Topical↗
PubMed1976

The problem of pressure sores in a nursing home population: statistical data.

This study on 93 patients was conducted at a skilled nursing facility. Twenty-two of the 93 patients had pressure sores; 34 of the 54 sores were present when the patients were admitted and 20 developed after admission. Only 5 of the 54 sores healed. Healing times ranged from 15 to 55 days after the beginning of treatment. Thirteen deaths occurred among the 71 patients without sores, and 17 deaths among the 22 patients with sores. Specific treatment regimens varied (cleaning solutions, antimicrobial drugs, heat, enzymatic debridement) but always included frequent changes in the position of the patient. Ten of the 22 patients with sores were anemic vs. 19 of the 71 patients without sores. Half of the patients with sores were maintained with tube feedings whereas more than half of the patients without sores received regular house diets. Pressure sores are a serious problem among geriatric patients in nursing homes. All those who care for the aged should be fully aware of the procedures involved in the prevention and management of these sores.

Adult↗
PubMedDate not supplied

Heparin requirements in pulmonary embolism and venous thrombosis: a prospective study.

To investigate the relationship between the clinical diagnosis of thromboembolic disease and heparin requirements for anticoagulation, we prospectively studied 31 patients suspected to have either deep vein thrombosis or pulmonary embolism. Six had the diagnosis of pulmonary embolism confirmed by a combination of ventilation and perfusion scans with pulmonary angiography, eight had venograms showing deep vein thrombosis, seven had diseases which mimicked pulmonary embolism, and ten had normal venograms. These four diagnostic groups were not significantly different with respect to heparin requirements during the first 24 hours of therapy (mean +/- S.D. = 426 +/- 105, 507 +/- 105, 434 +/-79, and 457 +/- 46 units/kg per 24 hours, respectively). Patients with pulmonary embolism and deep vein thrombosis did not differ significantly with respect to heparin requirements (UNITS/kg per 24 hours) on the second (386 +/- 108 vs. 439 +/- 127), third (415 +/- 136 vs. 464 +/- 130), and fourth (374 +/- 104 vs. 418 +/- 127) days of therapy. Our data suggest that the clinical diagnosis does not affect the dose of heparin necessary to anticoagulate patients with pulmonary embolism and deep vein thrombosis.

Adult↗