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Biomedical subjects

R Shane

Publications and source records attributed to R Shane.

At least 37 records · Page 2Linked to original sources
PubMed1994

Strategic management of therapeutic advances: experience with colony-stimulating factors.

Recent therapeutic advances offer significant opportunities for improved patient outcomes while challenging our ability to deliver these outcomes in a cost-effective manner. This report describes the strategies for managing such advanced therapies--specifically, the recently introduced colony stimulating factors (CSFs)--that have been adopted at Cedars-Sinai Medical Center. Based on the principles of Continuous Quality Improvement (CQI), our approach begins with a multidisciplinary task force that develops and continuously refines guidelines for use of these agents. To provide immediate feedback when physician orders do not conform to the guidelines, the pharmacist notifies a physician expert, who promptly contacts the prescriber for a discussion of the case and how the guidelines do or do not apply. Since the introduction of CSFs, cost per admission has declined from $983 to $729 (26%) for oncology patients and from $737 to $281 (62%) for HIV patients. Although it is impossible to rigorously establish how much of this decrease has resulted from our proactive management strategy, costs have consistently decreased following each task force intervention.

Biotechnology↗
PubMed1994

Development and implementation of practice guidelines (Part 1).

Development and implementation of practice guidelines should be a team effort that includes pharmacists, the medical staff, and hospital administration. Described in this article are the steps involved in developing and successfully implementing practice guidelines. Also briefly presented are some practice guidelines developed by the staff at Cedars-Sinai Medical Center for the use of ondansetron in the post-op setting, colony stimulating factors, and sumatriptan for the treatment of migraine. Finally, discussion of a few practice guidelines that are in the implementation phase and future directions with regard to evolution of practice guidelines are presented.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Department of pharmacy-initiated program for streamlining empirical antibiotic therapy.

The outcome of a department of pharmacy-initiated "streamlining" study designed to promote cost-conscious modifications of empirically selected antibiotic therapy is described. Two hundred forty-one evaluable adult patients started on restricted-use antibiotics at this university-affiliated community private teaching hospital were enrolled in a 9-week prospective streamlining study. Patients were alternately assigned to a Control (i.e., no pharmacist-initiated streamlining recommendations offered based on culture and susceptibility reports) or a Pharmacist Intervention group (i.e., pharmacist offers recommendations to streamline therapy). A statistically significant greater number of patients had their empiric antibiotic treatment courses modified to more appropriate antibiotic choices after receipt of culture and susceptibility reports among private prescribers in the Pharmacist Intervention group (83%) than in the Control group (38%) (p = .006). Additionally, pharmacists were overall successful in gaining prescriber acceptance for 64% of recommended changes of empiric antibiotic treatment courses before the receipt of culture and susceptibility reports (e.g., dose and/or frequency changes). There was no program effect observed with respect to improved physician response to microbiologic data that would allow streamlining empirical antibiotic choices in the Housestaff (i.e., medical or surgical residents), or infectious disease consultant prescriber groups. Projected overall annual cost savings that would be achieved as a result of continued efforts by pharmacists directed at streamlining empirical "restricted" antibiotic regimens is approximately +40,000.

Analysis of Variance↗
PubMed1991

An adverse drug reaction reporting system as an integral part of a drug-usage evaluation program.

The Adverse Drug Reaction program at CSMC identifies patients whose charts have been encoded with an ICD-9 code of E930 through E949, inclusively. Incidences per drug or drug category have permitted the Department of Pharmacy, acting through the Pharmacy and Therapeutics Committee, to review patient charts, identify trends and risk factors, and subsequently develop usage criteria for DUE studies. It is hoped that these activities will result in an improvement in usage of these drugs and a reduction in adverse drug reactions to them.

Digoxin↗
PubMed1989

Clinical career ladders: application to hospital pharmacy practice.

The reasons for job dissatisfaction among hospital pharmacists are reviewed, and an option for ameliorating the problem by offering clinical career ladders is advanced. Not enough new pharmacists are being trained to replace those leaving the profession, and hospital pharmacy managers seeking to recruit and retain quality pharmacists are facing stiff competition from retail outlets, academia, and the pharmaceutical industry. Hospital staff pharmacists report less of a sense of accomplishment than other workers and are more likely to change jobs. Although inadequate pay and benefits are frequently cited, one investigator found that the greatest source of dissatisfaction was the lack of opportunity for advancement. Other professions facing similar problems have experimented with a system of parallel career ladders in which alternatives to the traditional managerial advancement track are offered. Staff nurses on a clinical ladder remain in a direct patient-care role while ascending a hierarchy of clinical practice levels; each level brings greater responsibility and rewards. Outcomes have included improved recruitment, decreased turnover, and increased interest in educational programs. In pharmacy, each level of a clinical career ladder would be defined by explicit criteria for knowledge and skill in patient care and drug therapy. As in nursing, such a ladder would create advancement opportunities and reward the acquisition of knowledge and skills. Several hospital pharmacy departments now offer clinical career ladders. Implementation of clinical career ladders has the potential to enhance the job satisfaction of hospital pharmacists and improve their recruitment and retention.

Career Mobility↗