Pharmacy-based adverse drug reaction surveillance program.
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Drug-Related Side Effects and Adverse Reactions↗
Biomedical subjects
S H Powell
Publications and source records attributed to S H Powell.
Postgraduate pharmacy fellowships.
During May 1981, the Pharmacy Services Department of the Brigham and Women's Hospital conducted a national survey by mail questionnaire regarding postgraduate pharmacy fellowships. There was a total response rate of 74 percent to the questionnaire. Fifty-eight fellowships are offered at 26 fellowship sites. Information regarding type of specialty fellowship, fellowship characteristics, fellowship location and contact person, and qualifications of applicants is reported.
Education, Pharmacy, Graduate↗
Are measurements of urine enzymes useful during aminoglycoside therapy?
We prospectively evaluated concentrations of beta-D-galactosidase, alpha-L-fucosidase, beta-D-N-acetylglucosaminidase, and lysozyme in urine from normal subjects, ambulatory patients with cystic fibrosis (CF), and CF patients with previously normal renal function who were receiving intravenous aminoglycoside (AG) therapy. Enzyme activities were generally low or negligible in subjects not receiving AG. Enzymuria was documented during 12 of 13 AG treatment courses and most frequently involved beta-D-N-acetylglucosaminidase excretion. In nine courses, enzymuria occurred in the absence of proteinuria or elevations of blood urea nitrogen and serum creatinine. In three courses attended by enzymuria and evidence of nephrotoxicity, neither the time of appearance nor the magnitude of enzymuria was different from that of nonnephrotoxic patients. In two of these three treatment courses, enzymuria preceded clinical evidence of nephrotoxicity of 16 and 5 days, and in the third course enzymuria and elevation of blood urea nitrogen and serum creatinine occurred simultaneously. We conclude that enzymuria is not a reliable predictor of nephrotoxicity due to AG in CF patients and is not an indication of discontinue AG therapy.
Acetylglucosaminidase↗
Concurrent pharmacist monitoring of gentamicin therapy.
The results of concurrent monitoring of gentamicin therapy by a clinical pharmacist are reported. All patients in a 332-bed teaching hospital who were started on gentamicin therapy during a 72-day period were monitored. Predetermined criteria concerning maximum daily gentamicin dose based on serum creatinine and acceptable precautions for avoiding toxicity (i.e., serum creatinine, gentamicin serum level determinations) were used. Deviations from these criteria resulted in contact with the patient's physician, and specific recommendations were made by the pharmacist at that time. During this period, 120 courses of gentamicin therapy were monitored in 101 patients. Major criteria deviations were found in 15 (12.5%) courses, resulting in the contact of 10 physicians. Physicians responded to the pharmacists' recommendations in 9 (60%) of the 15 courses. It is concluded that a clinical pharmacist can interact effectively with physicians in monitoring drug therapy in the hospital.
Boston↗
The structure and function of a clinical pharmacology consulting service.
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Consultants↗
How well can physicians estimate mortality in a medical intensive care unit?
The accuracies of physicians' predictions of mortality for 523 patients in a medical intensive care unit were compared with estimates derived from a logistic model. The model utilized a popular severity-of-illness measure, the APACHE II. Accuracy was assessed through its components resolution (discrimination) and calibration. Physicians could better discriminate survivors from nonsurvivors, as measured by the area under the receiver operating characteristic curve (0.89 for physicians vs 0.83 for APACHE II model, p less than 0.001) and by resolution (0.103 for physicians vs 0.130 for APACHE II model, p less than 0.001). Overall, the APACHE II model was better calibrated (0.003 for APACHE II vs 0.021 for physicians, p less than 0.001). While the APACHE II model was better calibrated in the central probability ranges, physicians could more accurately identify those most likely to die. Decisions on withholding or withdrawing treatment are being made daily in intensive care units based on physicians' subjective prognostic estimates. At least for experienced physicians at a major medical center, these estimates are comparable in accuracy to quantitative models.
Decision Making↗