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Biomedical subjects

R Segal

Publications and source records attributed to R Segal.

At least 163 records · Page 9Linked to original sources
PubMed1988

Prescribing authority for pharmacists as viewed by organized pharmacy, organized medicine, and the pharmaceutical industry.

This study identifies attitudes of organized pharmacy, organized medicine, and the pharmaceutical industry about prescribing authority for pharmacists. A questionnaire designed to assess the impact of a legislative bill permitting a pharmacist in an organized health care setting to initiate or modify drug therapy was mailed to state pharmacy associations, state hospital pharmacy associations, state pharmacy boards, state medical associations, Pharmaceutical Manufacturers Association (PMA)-member manufacturers, and non-PMA-member generic manufacturers. Responses from 194 of the 307 invited organizations were used. The six organization types viewed the impact of the legislative bill differently (p less than 0.05). Hospital pharmacy associations and boards of pharmacy, to a lesser extent, supported the legislative bill; non-PMA-member generic manufacturers and state pharmacy associations were relatively neutral. The medical associations and the PMA-member companies opposed the passage of the bill. Furthermore, medical associations believed that the bill would not be passed in the majority of states in the next five years.

Attitude of Health Personnel↗
PubMed1988

Ulnar neuropathy caused by fat necrosis with cystic myxoid degeneration at the upper forearm: case report.

The case described is thought to be the first report of ulnar neuropathy caused by a cystic myxomatous degeneration of fat necrosis. The 12-day preoperative duration of symptoms is also the shortest reported for nontraumatic ulnar neuropathy; the average period between onset of symptoms and operation is 10 months. At operation, the patient's nerve was found to be stretched severely over the tumor, which was excised, thus decompressing the ulnar nerve. The procedure relieved the patient's symptoms of tingling and numbness, and he remained asymptomatic at the 12-month follow-up examination.

Aged↗
PubMed1988

Formulary decision making: identifying factors that influence P&T committee drug evaluations.

This study identifies outcomes related to hospital formulary decision making and estimates the importance of 16 specific types of data to five P & T Committees during the formulary decision making process. The two most important outcomes, according to the Committee members involved in this study, were the effects of the potential formulary addition on the quality of drug treatments available in the hospital followed by its impact on hospital costs. Information about the therapeutic advantage of the potential drug addition, the relative adverse effect profile, and cost information were viewed as especially important. On the other hand, promotional literature provided by pharmaceutical companies and letters of evaluation from respected physicians at hospitals other than their own, were not viewed as important. By understanding the factors involved in hospital formulary decision making, strategies encouraging optimal formulary decisions may be developed.

Data Collection↗
PubMed1988

Sensitivity and specificity of three methods of detecting adverse drug reactions.

The sensitivity and specificity of three methods of detecting adverse drug reactions (ADRs) were determined. Minimal use of a voluntary ADR reporting program prompted this investigation of three ADR detection methods, as follows: screening of laboratory reports, pharmacist screening of medication orders, and voluntary reporting. A total of 98 patients who were receiving oral or i.v. digoxin therapy, oral or i.v. theophylline therapy, or i.v. gentamicin therapy were randomly selected and monitored for possible ADRs. A physician reviewed the charts of patients with suspected ADRs using the Naranjo algorithm to assess causality. The chart review served as the reference method to which the other three methods were compared. Thirteen "true" (i.e., confirmed by the Naranjo algorithm) ADRs were identified in 11 different patient charts, resulting in a 13.3% ADR incidence rate for the 98 sampled patients. For the three ADR detection methods, the decreasing order for level of sensitivity was screening of laboratory reports, pharmacist screening of medication orders, and voluntary reports; however, only the difference between laboratory reports and voluntary reports was significant. For level of specificity, the decreasing order for the three methods was voluntary reports, pharmacist screening of medication orders, and pharmacist screening of laboratory reports; the differences among all three methods were significant. Screening of laboratory reports and pharmacist screening of medication orders are two detection methods that appear to exhibit an appropriate combination of sensitivity and specificity for identifying ADRs; trials with larger sample sizes are needed to confirm the results of this study.

Algorithms↗
PubMed1988

Simple methods for estimation of prednisone intake and metabolism.

For patients treated with high doses of prednisone (over 40 mg/day) laboratory follow-up is important, particularly when the therapeutic response does not correlate with the dose of prednisone prescribed. Taking advantage of the similarity in structure of prednisone to cortisone and of prednisolone to cortisol we evaluated simple, inexpensive methods for the assessment of prednisone and prednisolone intake and bio-availability. Free urinary prednisolone was estimated by radioimmunoassay for cortisol and found to be linearly correlated with the dose of prednisone administered (r = 0.9310). Levels of free prednisolone were 6.5-11% of the dose of prednisone per day. Free and metabolized prednisone and prednisolone were estimated as 17-OHCS in the 24-hr urine collection. Total, conjugated and free 17-OHCS were linearly correlated with the dose of prednisone, the best correlation being with total 17-OHCS (r = 0.9060). About 40% of the prednisone administered was secreted as total 17-OHCS.

Adult↗
PubMed1988

Glycyrrhizin gel as vehicle for idoxuridine topical preparation: skin permeation behaviour.

The in vitro skin permeation behaviour of idoxuridine (IDU) from a new preparation containing glycyrrhizin gel as carrier was tested and compared with that from a commercial IDU ointment (Virusan) at two temperatures on intact and stripped skin. At 34 degrees C the normalized flux (Fn) values were six times higher for the IDU glycyrrhizin gel than for Virusan when tested on intact hairless mouse skin. At 25 degrees C, Fn values were 22 and 25 times greater for the gel formulation using intact and stripped skin, respectively. These in vitro results, showing that IDU penetrates the skin more effectively when incorporated in the glycyrrhizin gel than in the ointment, correlate well with the previously reported efficacy of the gel tested in vivo.

Animals↗
PubMed1988

Program planning of a biomedical communications center: an implementation-oriented approach.

This article illustrates application of (1) Nominal Group Technique and (2) Importance-Performance Analysis, both commonly used planning strategies, to the programmatic planning of a university-based biomedical communications center. The method described may prove useful when successful implementation of such a plan depends upon cooperation between diverse client groups within the organization.

Academic Medical Centers↗
PubMed1988

Opinions of pharmacy, medicine, and pharmaceutical industry leaders about hypothetical therapeutic-interchange legislation.

The beliefs of representatives of organized pharmacy and medicine and the pharmaceutical industry about the effect of hypothetical therapeutic-interchange legislation on various health-care issues were studied. Questionnaires designed to gauge respondents' beliefs about the impact of two hypothetical bills (A and B) concerning selection of therapeutic alternates by pharmacists were mailed to the directors of 307 organizations in April 1986. Bill A would permit pharmacists in any setting to select therapeutic alternates. Bill B would permit therapeutic interchange by pharmacists within organized health-care settings in accordance with guidelines approved by physicians. Issues addressed included the efficient delivery of health care, professional liability, interprofessional and pharmacist-patient relationships, and competition and profitability in the pharmaceutical industry. The response rate was 63% (194 usable responses). Bill A received some support from representatives of state pharmaceutical associations only. However, bill B was supported by respondents from state pharmaceutical associations, state hospital pharmacy societies, boards of pharmacy, and generic manufacturers. Respondents from medical associations and member companies of the Pharmaceutical Manufacturers Association (PMA) were concerned about the impact of the hypothetical bills on the quality of drug therapy and the efficiency of health-care delivery. Respondents from medical associations also were concerned about the impact of the bills on physician liability. The responses from the medical associations and the PMA-member companies suggest that a program should be developed to educate physicians about the process used by pharmacists and physicians to develop guidelines for therapeutic interchange in various practice settings.

Attitude of Health Personnel↗
PubMed1987

Differential involvement of central cholinergic mechanisms in the aversive stimulus properties of morphine and amphetamine.

Previously, it was reported that pretreatment with the centrally-acting cholinergic antagonist atropine, but not the peripherally-acting antagonist, methyl-atropine, may serve to attenuate the positive reinforcing properties of morphine and conversely, to enhance those of amphetamine as evidenced within a drug self-administration paradigm in rats. In parallel, evidence from several sources would suggest that there may be a functional relationship between the neurochemical mechanisms mediating these drugs' positive reinforcing properties and their seemingly paradoxical capacity to act as aversive stimuli, as evidenced within a conditioned taste aversion (CTA) paradigm. Accordingly, the present study undertook to examine whether a similar differential involvement of central cholinergic mechanisms established for these drugs' positive reinforcing effects may be obtained for morphine and amphetamine-induced CTA. Using a conventional CTA paradigm, animals were pretreated with either intraperitoneal (IP) atropine or methyl-atropine (0.6 mg/kg) 40 minutes prior to consuming a novel 0.1% saccharin solution. This taste stimulus was paired with IP injection of 15 mg/kg morphine or vehicle. Results showed that atropine (but not methyl-atropine) pretreatment served to attenuate the morphine CTA. In a second experiment, atropine-pretreatment failed to attenuate, and may have slightly potentiated, a CTA induced by 1 mg/kg amphetamine. Atropine pretreatment did not affect a CTA induced by the emetic agent, lithium chloride. Pretreatment with the peripherally-acting methyl-atropine had no effect on the amphetamine CTA and served, if anything, to slightly attenuate the lithium chloride CTA.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylcholine↗
PubMed1987

Estimation of prednisone intake in pemphigus vulgaris patients with the use of simple laboratory methods.

Prednisone is a widely used medication in dermatology, particularly in pemphigus patients. Simple objective laboratory methods are suggested for the evaluation of prednisone intake, taking advantage of the similar chemical structure of cortisol and prednisolone. A linear correlation was found between the dose of prednisone, above 40 mg/day, free urinary prednisolone, measured with an radioimmunoassay kit for cortisol that cross-reacts with prednisolone, and 17-hydroxycorticosteroids, measured by Metcalf's method. Approximately 9% of the prednisone administered was recovered as free prednisolone and about 40% as 17-hydroxycorticosteroids. It is suggested that these simple laboratory methods constitute a useful substitute for the more costly, sophisticated methods available at present for determining levels of prednisone and prednisolone.

17-Hydroxycorticosteroids↗
PubMed1987

Glycyrrhizin gel as a vehicle for idoxuridine--I. Clinical investigations.

The therapeutic efficacy of a new formulation that incorporates 0.2% IDU in glycyrrhizin gel has been tested on patients who suffer from herpes of the lips and nose. The preparation was significantly more effective than a commercial 0.5% IDU ointment. It reduced the healing time and produced an almost instantaneous relief from pain. The higher efficacy of the new preparation may be ascribed to the reported anti-inflammatory and antiviral activities of glycyrrhizin together with an enhanced permeation of the IDU through the skin.

Gels↗
PubMed1987

Two years of follow-up of oral ketoconazole therapy in 60 cases of pityriasis versicolor.

In a series of 60 patients (42 males, 18 females) with widespread lesions of pityriasis versicolor, 200 mg of oral ketoconazole was administered daily for a period of 24 days. Routine laboratory examinations, including microscopic and Wood's light examinations, were performed prior to initiation of treatment and twice during the treatment period as well as 3 and 6 months, and 1 and 2 years after completion of treatment. In 95% of the patients the clinical cure was maintained after 3 months but after 6 months it was still present in only 80% and after one year in only 57%. At the end of two years 60% showed relapse of the disorder. In 75% hypopigmented macules persisted after 6 months but without microscopic evidence of the fungus. No side effects were reported. It is evident that oral ketoconazole is effective in maintaining a clinical cure mainly during the first 3 months after treatment. The question as to whether side effects might appear with a more prolonged course of the drug should be given serious consideration before continuation of treatment is contemplated.

Administration, Oral↗
PubMed1987

Rapid response of transient acantholytic dermatosis to selenium sulfide treatment for pityriasis versicolor.

The observation of a 51-year-old male patient with transient acantholytic dermatosis (TAD) is briefly reported. The discrete eruption, composed of erythematous escoriated papules and papulovesicles, moderately itching, was located on the back and chest, more permanent during the summer season. The biopsy revealed suprabasal acantholysis and Darier-like elements. Lesions of pityriasis versicolor, confirmed by microscopic examination and fluorescence in Wood's light, were intermingled with TAD in the same patient. A topical treatment with selenium sulfide brought TAD lesions to the disappearance in 1 week. Comments are made in relation with the possibility of Malassezia furfur to induce acantholytic phenomena.

Acantholysis↗
PubMed1987

Implementation and evaluation of a flexitime program involving pharmacy i.v. admixture technicians.

The purpose of this article is to describe the implementation of a flexitime program involving i.v. admixture personnel and to evaluate its impact on three work-related behaviors. Flexitime, also known as flex-time, is an alternative to the standard work schedule. Flexitime programs have been shown to have a positive effect on productivity, overtime, turnover, tardiness, absenteeism, and job satisfaction in various work settings. The i.v. admixture technicians and interns chose a flexitime program called the variable day. During both the baseline and the flexitime period, three work-related behaviors were measured: absenteeism, tardiness, and satisfaction. Tardiness was almost eliminated during the flexitime program; absenteeism decreased from 4.61% during the baseline period to 2.66% during the flexitime program, although this difference was not statistically significant. General job satisfaction did not significantly change during the flexitime program. Overall, all of the technicians favored the flexitime program and suggested that it be expanded to include the unit dose technicians. If future investigations support the usefulness of flexitime programs, pharmacy managers should consider its implementation as an additional strategy for reducing departmental costs.

Evaluation Studies as Topic↗
PubMed1987

Pharmacists' opinions about and compliance with recommendations for intravenous admixture practices.

Hospital pharmacy departments nationwide were surveyed to determine compliance with and opinions on the importance of recommended practices for preparation of i.v. admixtures. Questionnaires that included 84 recommendations by the National Coordinating Committee on Large-Volume Parenterals, the American Society of Hospital Pharmacists, and the Joint Commission on Accreditation of Hospitals were mailed to 625 randomly selected acute-care hospitals. Questions covered the compounding area and recommended equipment; selection, education, and training of personnel; compounding procedures; quality assurance; labeling and record keeping; and reference materials and professional services. The response rate was 43% (198 usable replies). Responses indicated that 42 (50%) of the recommended practices were followed in fewer than 75% of the hospitals, 25 (30%) in fewer than 50% of the hospitals, and 17 (20%) in fewer than 25% of the hospitals. Twenty of the recommendations were considered marginal in importance. Adherence to published guidelines for i.v. admixture services varies among hospitals in the United States; compilation of a single set of guidelines should be considered.

Allied Health Personnel↗